gastrointestinal disorders
Ulcerative Colitis
Key Points
Ulcerative colitis begins in the rectum and may extend proximally in a contiguous fashion without intervening patches of normal bowel. Symptoms are intermittent episodes of abdominal cramping and bloody diarrhea. Complications include fulminant colitis, which may lead to perforation; long-term, the risk of colon cancer is increased. Treat mild disease with 5-ASA by rectum and, for proximal disease, by mouth. Treat extensive disease with high-dose corticosteroids, immunomodulator therapy (eg,azathioprine, 6-mercaptopurine), biologics (eg,adalimumab,infliximab,vedolizumab),tofacitinib,upadacitinib, orozanimod. Treat fulminant disease with high-dose IV corticosteroids orcyclosporineand antibiotics (eg,metronidazole,ciprofloxacin) orinfliximab; colectomy may be required. About one third of patients with extensive ulcerative colitis ultimately require surgery. 