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

Mark A Peppercorn, MD
Sunanda V Kane, MD, MSPH
Section Editor
Paul Rutgeerts, MD, PhD, FRCP
Deputy Editor
Kristen M Robson, MD, MBA, FACG


Ulcerative colitis is characterized by recurring episodes of inflammation limited to the mucosal layer of the colon. It commonly involves the rectum and may extend in a proximal and continuous fashion to involve other parts of the colon.

This topic will review the clinical manifestations, diagnosis, and natural history of ulcerative colitis. The definition, epidemiology, pathogenesis, and treatment of ulcerative colitis are discussed in detail, separately. (See "Definition, epidemiology, and risk factors in inflammatory bowel disease" and "Management of mild to moderate ulcerative colitis in adults" and "Management of severe ulcerative colitis in adults" and "Approach to adults with steroid-refractory and steroid-dependent ulcerative colitis".)


Colitis — Patients with ulcerative colitis usually present with diarrhea, which may be associated with blood. Bowel movements are frequent and small in volume as a result of rectal inflammation. Associated symptoms include colicky abdominal pain, urgency, tenesmus, and incontinence [1]. Patients with mainly distal disease may have constipation accompanied by frequent discharge of blood and mucus.

The onset of symptoms is usually gradual, and symptoms are progressive over several weeks. Symptoms may be preceded by a self-limited episode of rectal bleeding that occurred weeks or months earlier.

The severity of symptoms may range from mild disease with four or fewer stools per day with or without blood to severe disease with more than 10 stools per day with severe cramps and continuous bleeding [1]. (See 'Disease severity' below.)

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Literature review current through: Nov 2017. | This topic last updated: Aug 21, 2017.
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