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- Chronic relapsing and remitting inflammatory bowel disease causing recurrent episodes of diarrhea that is often bloody and accompanied by abdominal pain, incontinence, fever, and weight loss
- Inflammation limited to the colonic mucosa
- Colonic involvement is universal but may be accompanied by large joint arthritis, ocular inflammation, skin lesions, biliary disease, liver disease, thromboembolic disease, and (rarely) pulmonary complications
- North America: 19/100,000 person-years (1)
- Europe: 24/100,000 person-years (1)
- Asia and Middle East: 6.3/100,000 person-years (1)
- Increased risk of preterm delivery and small for gestational age birth
- 30% with inactive disease relapse in pregnancy
- Management with gastroenterologist and/or maternal–fetal medicine specialist/obstetrician is recommended.
Etiology and Pathophysiology
- Idiopathic; hypothesized association with autoimmune dysfunction, genetic predisposition, diet, and colonic microbiome
- Almost universally involves terminal colon, >95% of patients have rectal involvement, 50% have disease limited to rectum and sigmoid; 20% have pancolitis.
Moderate heritability. Specific genetic markers have not been identified.
- Age: variable, peak incidence 15 to 40 years of age
- First-degree relative with ulcerative colitis (UC)
- Theorized risk factors include disruption of colonic microbiome by diet or infection, dietary factors (Western diet in particular), antibiotic use, lack of breastfeeding in infant, obesity, and NSAID use.
No known preventive measures
- Breastfeeding may protect against pediatric inflammatory bowel disease.
- UC more likely pancolonic at onset and shorter time from diagnosis to colectomy (median 11.1 years)
Commonly Associated Conditions
- Arthritis: large joint, sacroiliitis, ankylosing spondylitis
- Pyoderma gangrenosum (rare)
- Erythema nodosum (common)
- Aphthous ulcers
- Episcleritis and uveitis (rare)
- Autoimmune liver disease (rare)
- Fatty liver (common)
- Liver cirrhosis (rare)
- Primary sclerosing cholangitis (rare)
- Bile duct carcinoma (rare)
- Thromboembolic disease (rare)
- Colon cancer (rare)
- Anemia (rare)
- Pulmonary diseases (very rare)