Clinical aspects of ulcerative colitis in mainland China

Inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), is reported to be increasing in incidence and prevalence in provinces and cities in mainland China. This article specifically reviews clinical features, extra-intestinal manifestations, complications, diagnosis and differential diagnosis, and medical treatment of UC. Compared to patients in Western countries, more mild to moderate and left-sided colitis cases were observed in a nation-wide study in China. Complications included anal fistula, anal abscess, anal fissure, severe bleeding, intestinal perforation, intestinal obstruction and colonic carcinoma. The extra-intestinal manifestations were arthritis/arthralgia, eye and skin disorders and oral ulcers. The high specificity of antineutrophil cytoplasmic antibody may useful for distinguishing UC from infectious colitis; in addition, serum levels of anti-saccharomyces cerevisiae antibody may be helpful for distinguishing between UC and CD. Oral sulfasalazine and 5-aminosalicylic acid (ASA) remain the mainstays for the management of mild to moderate UC in China. Corticosteroids and immunosuppressive agents are also widely used in severe or refractory UC.