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Clinical manifestations, diagnosis, and prognosis of ulcerative colitis in adults

INTRODUCTION

Ulcerative colitis is characterized by recurring episodes of inflammation limited to the mucosal layer of the colon. It almost invariably involves the rectum and may extend in a proximal and continuous fashion to involve other portions of the colon. Different terms are used to described the degree of involvement:

  • Ulcerative proctitis refers to disease limited to the rectum.
  • Distal colitis or proctosigmoiditis is used when the inflammatory process extends into the mid-sigmoid colon, usually reachable by the 60 cm flexible sigmoidoscope.
  • Left sided colitis for disease extending to but not beyond the splenic flexure.
  • Extensive colitis is defined as disease that extends beyond the splenic flexure but not as far as the cecum.
  • Pancolitis is used when the inflammatory process extends to the cecum.

The clinical manifestations, diagnosis, differential diagnosis, and natural history of ulcerative colitis will be reviewed here. The management of this disorder is discussed separately. This discussion is consistent with guidelines published by the American College of Gastroenterology [1]. (See "Medical management of ulcerative colitis".)

SIGNS AND SYMPTOMS

Patients with ulcerative colitis can have a variable presentation. For therapeutic and prognostic purposes, it has been useful to classify these presentations as mild, moderate, or severe. The severity of the symptomatology often correlates with the anatomic extent of disease, another parameter that will guide therapy.

Mild disease — Patients whose disease is confined to the rectum (proctitis) or rectosigmoid (proctosigmoiditis or distal colitis), often present insidiously with intermittent rectal bleeding associated with the passage of mucus, and the development of mild diarrhea with fewer than four small loose stools per day. Mild crampy pain, tenesmus, and periods of constipation are also common, but severe abdominal pain, profuse bleeding, fever, and weight loss are not part of the spectrum of mild disease.
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