Diagnosis begins with a thorough history and physical examination. Key factors include the duration, frequency, and characteristics of diarrhea, as well as associated symptoms like weight loss or fever.
A history of recent antibiotic use could indicate a Clostridium difficile infection, which might mimic UC symptoms. An evaluation of stool characteristics, including presence of blood or mucus, and any nocturnal diarrhea is crucial.
A family history of IBD or colorectal cancer, alongside other systemic symptoms like joint pain or skin lesions, can provide additional diagnostic clues.
The physical examination might reveal anaemia, abdominal tenderness, or perianal abnormalities. Digital rectal examination, while not always pleasant, can sometimes uncover hidden pathologies. Extra-intestinal manifestations such as eye inflammation, skin lesions, or joint pain can also suggest underlying IBD.
Diagnosing UC involves ruling out other conditions with similar presentations. Tests such as faecal calprotectin are useful to differentiate IBD from irritable bowel syndrome, as elevated levels indicate intestinal inflammation.
Endoscopy, including colonoscopy, is essential for visualising the colon and rectum, assessing the extent of inflammation, and identifying mucosal changes characteristic of UC. The Mayo score is used to classify disease severity from mild to severe based on endoscopic findings.
The goals of treatment are to control inflammation, induce and maintain remission, and improve the patient’s quality of life while minimising side effects. Long-term management often requires a multidisciplinary approach involving gastroenterologists, dietitians, and other specialists to address the various aspects of the disease and its impact on daily life.
The treatment of UC aims to induce and maintain remission while preventing complications. The management approach is tailored to the disease severity and the patient’s response to previous treatments.
Initial treatment often involves 5-aminosalicylic acid compounds, which are effective for inducing and maintaining remission in mild to moderate cases. These can be administered orally or rectally depending on the extent of the disease.
For moderate to severe cases, corticosteroids (CS) such as prednisone or budesonide are used to quickly induce remission. However, due to potential side effects like weight gain, hypertension, and osteoporosis, CS are not suitable for long-term use. Their use is typically limited to short-term management and bridging to other therapies.
Immunomodulators, including azathioprine and 6-mercaptopurine, are effective for maintaining remission and reducing steroid dependency, but they take several weeks to become effective and require regular monitoring due to potential side effects. Methotrexate may be used in some cases, though its application is less common.
Biologics such as anti-TNF agents (eg infliximab, adalimumab) offer targeted therapy by addressing specific immune responses involved in UC. These are particularly useful in severe cases or when patients are unresponsive to conventional therapies. Newer options like integrin inhibitors and small molecules are emerging, offering additional choices for managing UC.
In summary, managing UC effectively involves accurate diagnosis, targeted therapy, and regular monitoring to adjust treatment as needed and address potential complications.
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