Ulcerative colitis | Radiology Reference Article …

Ulcerative colitis (UC) is an inflammatory bowel disease which predominantly affects the colon, but also has extraintestinal manifestations.

Typically ulcerative colitis manifests in young adults (15-40 years of age) and is more prevalent in males but onset of disease after age 50 is also common 1,3,5. A combination of environmental and genetic factors are thought to play a role in the pathogenesis, although the condition remains idiopathic.

Nonsmoking is associated with UC; ex-smokers are at higher risk for developing UC than non- smokers5.

Clinically patients have chronic diarrhoea (sometimes bloody) associated with tenesmus, pain and fever 1.

Unlike Crohn's disease which is characteristically a transmural disease, ulcerative colitis is usually limited to the mucosa and submucosa 5. Chronic disease is associated with a significantly elevated malignancy risk, of up to 0.5-1.0% per year after 10 years of disease.

The diagnosis is often made with endoscopy, which also allows biopsy of any suspicious areas.

Involvement of the rectum is almost always present (95%) 1, with the disease involving variable amounts of the more proximal colon, in continuity. The entire colon may be involved, in which case oedema of the terminal ileum may also be present (so-called back-wash ileitis).

In very severe cases, the colon becomes atonic, with marked dilatation, worsened by bacterial overgrowth. This leads to toxic megacolon which although uncommon has a poor prognosis.

Non specific but may show evidence of mural thickening (more common), with thumbprinting also seen in more severe cases.

Double contrast barium enema allows for exquisite detail of the colonic mucosa, and also allows bowel proximal to strictures to be assessed. It is however contraindicated if acute severe colitis is present due to the risk of perforation.

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Ulcerative colitis | Radiology Reference Article ...