Ulcerative Colitis Background
Ulcerative Colitis

Symptoms and Diagnosis
of Ulcerative Colitis

An accurate diagnosis is the first step toward proper treatment.

Definition & Types

What is Ulcerative Colitis?

Ulcerative colitis is an autoimmune disease and, along with Crohn's disease, is a type of Inflammatory Bowel Disease (IBD). It is a chronic inflammatory bowel disease that occurs in the mucosa and submucosa of the large intestine, characterized by inflammation that begins in the rectum and spreads continuously.

Classification by Extent of Inflammation
  • • Proctitis: About 90% of patients (inflammation only in the rectum)
  • • Left-sided colitis: Affects the descending and sigmoid colon
  • • Pancolitis: Inflammation throughout the entire large intestine

While previously known to occur mostly in childhood and adolescence, the incidence rate has recently been increasing in middle-aged and older adults as well.

Large Intestine Structure
Causes

Causes of Onset

It occurs due to a complex interplay of various factors.

FACTOR 01

Genetic Predisposition

Genetic background such as family history

FACTOR 02

Immune Dysfunction

Imbalance of autoimmune responses

FACTOR 03

Gut Microbiota

Changes in the microbial ecosystem

FACTOR 04

Environmental Factors

External factors like diet, stress, etc.

Symptoms

Symptom
Checklist

The intensity of symptoms varies depending on the individual, range of lesions, activity level, etc.

Local Symptoms

Colonic Symptoms

  • • Bloody stool: Bloody diarrhea (diarrhea mixed with blood)
  • • Mucous stool: Stool mixed with mucus that looks like nasal discharge
  • • Diarrhea: Loose stool, unformed stool, or watery diarrhea
  • • Urgency: Inability to hold bowel movements for 5 minutes after feeling the urge
  • • Abdominal pain: Primarily spasmodic lower abdominal pain
Systemic Symptoms

Systemic Symptoms

  • • Fatigue: Chronic lethargy
  • • Weight loss: Due to malabsorption and loss of appetite
  • • Fever: Occurs when inflammation is severe
  • • Anemia: Iron deficiency anemia due to excessive bleeding
Diagnosis

Diagnostic Testing

From clinical symptom confirmation to precise testing, various methods are utilized for an accurate diagnosis.

Clinical Symptoms

Clinical Symptom Confirmation

Diagnosis is primarily made by confirming clinical manifestations such as diarrhea, bloody stool, and rectal bleeding.

Endoscopy

Colonoscopy & Biopsy

The Golden Standard for directly observing inflammation and ulcers in the mucosa. If necessary, a biopsy is performed to confirm inflammatory changes.

Stool Test

Stool Test (Calprotectin)

Tests for Calprotectin, an inflammatory marker in the stool, as well as occult blood. It has a high concordance rate with endoscopy.

Blood and Imaging Tests

Blood and Imaging Tests

Blood tests (CRP, ESR, anemia) and, if necessary, abdominal CT or MRI are performed, but blood levels can have low reliability.

"Colonoscopy:
Necessary, but frequent testing can be risky."

The Golden Standard for diagnosing ulcerative colitis is the colonoscopy. However, colonoscopies carry potential risks and require caution.

  • Disruption of gut microbiota: The bowel prep solution taken before the test can wash away the microbiome and disrupt the bacterial flora, which may take months to recover.
  • Risk of physical damage: During the test, the scope can scratch or collide with the colon wall, potentially causing wounds, and in severe cases, bowel perforation may occur.

Especially in cases of severe ulcerative colitis, colonoscopies can exacerbate symptoms,
so they must only be performed when absolutely necessary.

Fecal Calprotectin

Fecal Calprotectin (FC) Test

Fecal calprotectin is a biomarker secreted by neutrophils during intestinal inflammation.
It has a high concordance rate with endoscopy of over 80% and is a reliable test with 93% sensitivity and 96% specificity.

Calprotectin Level Reference (mg/kg)
* Levels can also be elevated in bacterial/viral gastroenteritis, lymphoma, food allergies, etc., so differentiation is necessary.

Cautions in
Blood Test Interpretation

In actual clinical practice, blood test levels often appear normal even if colonic inflammation is severe, resulting in low reliability. They should be used for simple reference purposes only.

While elevated in infectious diseases, ulcerative colitis is non-infectious, so levels are often normal. Conversely, excessive use of immunosuppressants can lead to a drop in levels, causing weakened immunity. (Note: Levels may rise if there are complications like fistulas or abscesses in Crohn's disease.)

An acute inflammatory reactant; the normal range is typically < 0.5 mg/dL. It can also rise after heart attacks, infections, or strenuous exercise, making it difficult to view as an indicator specific to ulcerative colitis.

Indicates long-term inflammation; the average normal range is < 20 mm/h. There are variations depending on age and gender.

Complications

Complications of Ulcerative Colitis

  • Persistent colonic bleeding
  • Severe acute colitis (toxic megacolon)
  • Increased risk of colon cancer (sharp increase after 20 years of disease duration)
  • Perianal diseases such as hemorrhoids

F.A.Q

Frequently Asked Questions

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