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Ulcerative Colitis

Ulcerative Colitis is a topic covered in the 5-Minute Clinical Consult.

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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)

  • North America: 249/100,000 persons (1)
  • Europe: 505/100,000 persons (1)
Pregnancy Considerations
  • 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.

Risk Factors

  • 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.

General Prevention

No known preventive measures

Pediatric Considerations
  • 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)

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Stephens, Mark B., et al., editors. "Ulcerative Colitis." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116629/all/Ulcerative_Colitis.
Ulcerative Colitis. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116629/all/Ulcerative_Colitis. Accessed April 24, 2019.
Ulcerative Colitis. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116629/all/Ulcerative_Colitis
Ulcerative Colitis [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 24]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116629/all/Ulcerative_Colitis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Ulcerative Colitis ID - 116629 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116629/all/Ulcerative_Colitis PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -