Ulcerative colitis (CU; synonyms: colitis chronica purulenta; colitis polyposa; ulcerative colitis; ulcerative enteritis; gastroenteritis ulcerosa; ulcerative colitis; ulcerative enteritis; ulcerative enterocolitis; ICD-10-GM K51.-: Ulcerative colitis) is a chronic inflammatory disease of the superficial mucosa (mucosa and submucosa) of the rectum (rectum) and possibly the colon (colon; proximal spread). The infestation is usually continuous and originates from the rectum (always infested). In this way, the entire colon (ulcerative pancolitis, approx. 20 % of cases) and the terminal ileum (last section of the small intestine; “backwash ileitis”) may be affected. In about 40-50% of cases, ulcerative colitis manifests in the rectum and sigmoid (connection between the colon and rectum). In 30-40 % there is left-sided colitis (inflammation of the ascending colon) and in about 20 % of cases there is pancreatitis, i.e. inflammation of the entire colon. Typical is the appearance of so-called pseudopolyps, which are a characteristic sign of a longer existing disease. Due to the symptoms, ulcerative colitis can easily be confused with Crohn’s disease. Classification according to course:
- Chronic recurrent course
- Chronic continuous course
- Fulminant episode – clinical symptoms with systemic involvement (systemic: disease affecting multiple organs).
- Remission (temporary or permanent subsidence of disease symptoms, but without achievement of recovery).
Sex ratio: men and women are equally affected. Frequency peak: the disease occurs predominantly between the 25th and 35th year of life.In 15-25% of patients, the first symptoms appear before the age of 20, sporadically the disease begins in infancy. The prevalence of the disease in Europe and North America has increased over decades. It is now beginning to stagnate. It stands at 0.5% in Europe. In Asia, Africa and South America, the disease used to be rare but is now starting to increase significantly. The incidence (frequency of new cases) is about 6 cases per 100,000 inhabitants per year (in Germany). In total, about 150,000 Germans are affected. Course and prognosis: The course of ulcerative colitis is chronic-recurrent in 85 % of cases. Nevertheless, 5-10 % of patients who have had only one attack of the disease remain symptom-free for many years. In 10 % of cases, the course is chronic-continuous, i.e. the symptoms wax and wane in intensity. Complete remissions (permanent reduction of disease symptoms, but without recovery) do not occur. In a further 5% of patients, the course is acutely fulminant, i.e. the disease begins suddenly and severely.It is now known that diet plays only a minor role in the prevention of ulcerative colitis. On the other hand, it is of great importance when the disease is already present. Due to recurrent diarrhea and damage to the intestinal mucosa, patients are at high risk of malnutrition. Signs of malnutrition can be detected in 85% of children suffering from ulcerative colitis. Malnutrition is caused by the heavy protein losses via the inflamed intestinal mucosa. However, the supply of micronutrients such as iron, vitamin D, folic acid and zinc is also frequently inadequate, which has a negative effect on growth and development in children. In adults, the prevalence for malnutrition is 7.2%.The lethality (mortality related to the total number of people suffering from the disease) in these cases is up to 30%. After a disease course of more than ten years, ulcerative colitis patients have an increased risk of developing colon cancer (cancer of the colon or rectum). Thirty years after initial diagnosis, the cumulative risk of carcinoma is just under 20%. For pancreatitis (inflammation of the entire colon), the 20-year survival rate is > 80%. Ulcerative colitis is curable by proctocolectomy (surgical removal of the colon and rectum). Comorbidities: Patients with inflammatory bowel disease (IBD) are at increased risk for celiac disease (RR, 3.96; 95% CI, 2.23-7.02).Note: Children and adolescents are at increased risk for psychosocial problems and psychiatric illness.Patients with ulcerative colitis are also expected to have a 30 percent increased incidence of Parkinson’s disease.
