Clinical meaning
Ulcerative colitis involves continuous mucosal inflammation starting at the rectum and extending proximally. Driven by Th2 cytokine response (IL-5, IL-13) with neutrophilic crypt abscesses. Always involves rectum (vs Crohn which can skip). 5-ASA (mesalamine) is first-line for mild-moderate disease. Biologics (infliximab, vedolizumab) for moderate-severe. Increased colorectal cancer risk after 8-10 years requiring surveillance colonoscopy.
Diagnosis & workup
Diagnostics & workup: - ERCP for therapeutic biliary/pancreatic duct intervention - Anti-tTG IgA with total IgA for celiac disease screening - FibroScan or FIB-4 score for hepatic fibrosis staging - Hepatic function panel: AST, ALT, ALP, bilirubin, albumin - EGD with biopsy for upper GI pathology evaluation - H. pylori testing: urea breath test, stool antigen, or biopsy - Colonoscopy with polypectomy for lower GI assessment
Risk factors: - Diabetes with gastroparesis and motility dysfunction - Radiation therapy to abdomen causing enteritis - IBD family history (10-25% have affected first-degree relative) - Hepatitis B/C viral infection with cirrhosis progression - Obesity (BMI >30) increasing intra-abdominal pressure - H. pylori infection (most common cause of PUD worldwide) - NSAID use >2 weeks without gastroprotection