Common gastroenterological problems. V.-Ulcerative colitis

Symptoms such as diarrhoea and rectal bleeding are suggestive of ulcerative colitis but this diagnosis should never be made without confirmation by sigmoidoscopy and rectal biopsy and the possibility of infection excluded by stool culture and microscopy. A barium-enema is usually essential to assess the extent of the disease process. Treatment of the initial attack or subsequent relapses should be started as soon as possible and early referral to hospital is indicated, both for diagnostic confirmation and for therapeutic advice. The relapsing nature of the disease necessitates adequate follow-up and it should be possible for the patient to be seen at hospital with the minimum of delay. Most patients with colitis can be managed successfully by medical treatment, but occasionally emergency or elective proctocolectomy is indicated.