Pathogenesis and management of ulcerative colitis

The etiopathogenesis of ulcerative colitis (UC) is still largely unknown, although the role of genetic influences now seems to be fairly clear. Diagnosis is based on clinical, endoscopic and histological findings. The most important differential diagnosis of UC is Crohn's disease (CD). UC always first arises in the rectum and can spread continuously to upper parts of the colon. One of the severest complications consists in the development of toxic megacolon, which is seen in 1.6%-8% of cases. Another point is the occurrence of carcinoma in longstanding and extensive UC. The risk of this complication may have been overestimated in earlier studies: A realistic rate could be 0.5%-1% per person and year of pancolitis. However, carcinoma may occur even in less extensive cases. The conclusions which have to be drawn are still controversial. Some authors recommended regular endoscopy with serial biopsies, but others do not. The standard oral therapy is based on sulfasalazine (SASP) and corticosteroids. For topical treatment, 5(4)-amino-salicylic acid has proven to be effective in distal colitis, as has cortisone. Also, oral treatment with 5-ASA preparations seems to be beneficial, even if some of the published studies are open to criticism. Presumably, the drug is more clearly effective at higher doses than those commonly used.