Ulcerative colitis: clinic, modern diagnostic and treatment options

Vaida Vaitiekūnaitė1, Giedrius Putriūnas1, Ligita Bespalovaitė1

1Lithuanian University of Health Sciences, Faculty of Medicine, Kaunas, Lithuania


Ulcerative colitis is a chronic inflammatory disease that affects the mucosa of the large intestine. In patients with ulcerative colitis mucosal inflammation is starting in the rectum that can extend continuously to proximal segments of the colon. In the classic case, the disease begins to manifest in youth, but is sometimes diagnosed in older people as well. Ulcerative colitis usually presents with bloody diarrhoea but symptoms depends on the expansion of disease in the colon. Approximately 15% of patients can initially present with severe disease, which is characterized by systemic symptoms: weight loss, fever, general weakness. Ulcerative colitis characterized by extraintestinal lesions that are found in a third of patients, and a quarter of them have extraintestinal symptoms before presentation of typical ulcerative colitis symptoms. There is no single test method to confirm the diagnosis of this pathology. It is determined based on clinical data, colonoscopy, and histological examination. Laboratory tests are only additional in the diagnosis of ulcerative colitis. Radiological examination is also of little significance in confirming the diagnosis. For mild and moderate ulcerative proctitis topical mesalasine form in enemas or suppositories are recommended as first-line medications. For mild and moderate left colitis or pancolitis combination therapy 5 – ASA>3grams per day with topical mesalasine enemas or suppositories 1 time per day is recommended. Azathioprine is the first-line treatment for severe ulcerative colitis. When conservative treatment is ineffective according to literature golden standard surgical method for patients with ulcerative colitis restorative proctectomy by forming ileum as reservoir.

The aim of this article is to review the clinical manifestations of current colitis, modern diagnostic possibilities, the latest treatment recommendations of the disease based on the latest scientific literature. The object of the research is the topic of ulcerative colitis in publications published in scientific databases. The literature search was conducted in 2020. December 2021 January scientific databases: PubMed, UpToDate, and Clinical Key. Recent scientific articles were analyzed by keywords: ulcerative colitis, inflammatory bowel disease, toxic colonic enlargement. Consistent methods of publication analysis were applied based on a systematic literature review and a meta-analysis checklist.

Keywords: ulcerative colitis, inflammatory bowel disease, toxic megacolon.