Ulcerative Colitis: Diagnosis, Treatment, and Management
Sep 12, 2023
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Gilaad Kaplan, University of Calgary, discusses the latest information on ulcerative colitis including diagnostic tests, extra intestinal manifestations, skin conditions, treatment options, health maintenance needs, vaccine safety, prognosis, and life expectancy.
The prevalence of ulcerative colitis is estimated to be about 400 per 100,000 people, affecting approximately 1.5 million people currently.
Topical therapies like 5-aminosalicylic acid (5-ASA) are often used for mild to moderate ulcerative colitis, while advanced therapies like biologics and oral small molecules are available as first-line options for moderate to severe cases.
Deep dives
Epidemiology of Ulcerative Colitis
Ulcerative colitis is a bowel inflammation disorder with an incidence of roughly 15 per 100,000 people per year in North America. The prevalence in 2023 is estimated to be about 400 per 100,000 people, affecting approximately 1.5 million people currently. Diagnosis is typically based on symptoms like rectal bleeding, diarrhea, and bowel urgency, with additional diagnostic tests such as fecal calprotectin, stool cultures, and sigmoidoscopy or colonoscopy with biopsies to confirm the diagnosis.
Extra Intestinal Manifestations of Ulcerative Colitis
Many individuals with ulcerative colitis experience extra-intestinal manifestations, with roughly one in four presenting these symptoms before or after their diagnosis. Common manifestations include joint pain, specifically peripheral arthritis associated with bowel inflammation, and spondylitis and sacroiliitis occurring independently of bowel inflammation. Eye inflammation, skin conditions like erytheminidosum and pyroderma gangrenosum, as well as primary sclerosing cholangitis, are also associated with ulcerative colitis.
Evolution of Treatment and First-line Therapies for Ulcerative Colitis
The treatment of ulcerative colitis has evolved significantly, with a deeper understanding of the disease's pathogenesis leading to a range of therapeutic options. Mild to moderate disease is often managed with topical therapies like 5-aminosalicylic acid (5-ASA) for proctitis or a combination of oral and topical therapies for more extensive disease. For moderate to severe disease, prednisone is commonly used for induction therapy, but it is not effective for maintenance. Advanced therapies, including thiopurines, biologics, and oral small molecules, are now available as first-line options for moderate to severe ulcerative colitis.
Ulcerative colitis (UC) is a chronic inflammatory condition of the colon. Individuals with UC have a lower life expectancy and are at increased risk for colectomy and colorectal cancer. However, many new treatments are available. JAMA Senior Editor Karen E. Lasser, MD, MPH, speaks to Gilaad Kaplan, MD, MPH, University of Calgary, about the latest information related to this condition. Related Content: