ULCERATIVE COLITIS

PRESENTED BY:
G.DEEPSHIKA
170515882009
PHARMD 5TH YR
INTRODUCTION:
Definition: Ulcerative colitis is confined to the rectum and colon, causes continuous lesions, and affects
primarily the mucosa and the submucosa.
UC is a chronic inflammatory condition of the colon that is marked by remission and relapses. It is a form of
inflammatory bowl disease.

EPIDEMIOLOGY:
• Incidence: 8–15 per 100,000 persons
• Prevalence: 170–230 per 100,000 .
• UC is 3 times more common than Crohn disease.
ETIOLOGY:
• The cause of UC remains unclear, although interplay of genetic, infectious factors, and
immunologic factors clearly exists.
• A limited number of environmental factors have clearly been proven to either modify the disease
or regulate the lifetime risk of developing it. - These include: - Tobacco use. - Appendectomy. -
Antibiotic use. - Oral contraceptive pills.
PATHOPHYSIOLOGY:
• The pathophysiology of ulcerative colitis involves defects in the epithelial barrier, immune response,
leukocyte recruitment, and micro flora of the colon.
• The epithelial barrier has a defect in colonic mucin, and possibly tight junctions, leading to increased
uptake of luminal antigens.
• The lamina propria of the mucosa also has increased number of activated and mature dendritic cells which
include a large number of Toll-like receptors (TLR), specifically TLR2 and TLR4.
• There also seems to be an atypical T-helper (Th) cell response in patients with ulcerative colitis, specifically
Th2, which exerts a cytotoxic response against epithelial cells.
• Other immune-related factors that play a role include tumor necrosis factor alpha (TNF-alpha), Interleukin
13, and natural killer T-cells. Levels of IgM, IgA, and IgG are elevated in inflammatory bowel disease.
• A disproportionate increase in IgG1 antibodies is found in patients diagnosed with ulcerative colitis.
• Leukocyte recruitment is affected on two fronts. There is an upregulated release of the chemoattractant
CXCL8 in ulcerative colitis so that Leukocytes are recruited to the mucosa from systemic circulation.
• there is an up regulation of mucosal addressin cellular adhesion molecule-1 (Mad-CAM1) on the
endothelium of mucosal blood vessels which promotes leukocyte adhesion and extravasation into mucosal
tissue.
• Ulcerative colitis seems to also result, in part, from a homeostatic imbalance between enteric microflora
and the host's mucosal immunity.
Types of Ulcerative Colitis:
The type of ulcerative colitis you have depends on where it’s located in your body:

• Ulcerative proctitis: is usually the mildest form. It’s only in the rectum, the part of your colon
closest to your anus. Rectal bleeding may be the only sign of the disease.

• Proctosigmoiditis: your rectum and the lower end of your colon (sigmoid colon) You’ll have bloody
diarrhea, belly cramps, and pain, tenesmus.

• Left-sided colitis : causes cramps on that side of your belly. You’ll also have bloody diarrhea, and
you might lose weight without trying. You’ll have inflammation from your rectum up through the
left side of your colon.

• Pancolitis: often affects your entire colon. It can cause severe bouts of bloody diarrhea, belly
cramps, pain, fatigue, and major weight loss.
Complications:
CLINICAL PRESENTATION:
Physical examination:
• Hemorrhoids, anal fissures, or perirectal abscesses may be present.
• Iritis, uveitis, episcleritis, and conjunctivitis with ocular involvement.
• Dermatological findings with erythema nodosum, pyoderma gangrenosum, or apthous ulceration.
Laboratory test:
• Decreased hematocrit/ hemoglobin
• Increased ESR/CRP
• Leukocytosis and hypoalbuminemia
• (+) perinuclear antineutrophil cytoplasmic antibodies.

Diagnosis:
• Stool sample.
• Colonoscopy.
• Flexible sigmoidoscopy.
• CT scan.
TREATMENT:
Goals:
• To prevent relapses and maintenance of remission of ulcerative colitis
• To prevent ongoing GI damage
• Resolution of acute inflammatory processes.
• To prevent recurrence of bleeding
• To improve quality of life.
• To prevent complications.

Non pharmacological treatment:

• Nutritional support is very important because patient with moderate to severe disease
people are malnourished either because the inflammatory process results in significant
malabsorption.
• Eliminate the specific food that exacerbate the symptoms.
• Drink plenty of liquids and stay hydrated
• Try low fat food.
Pharmacological treatment:
THANK YOU.