ULCERATIVE COLITIS: A REVIEW OF ETIOPATHOGENIC, CLINICAL, DIAGNOSTIC, AND THERAPEUTIC ASPECTS

Abstract

Ulcerative colitis (UC) is one of the main inflammatory bowel diseases (IBD), along with Crohn's disease. UC is characterized by persistent inflammation of the colon and rectum mucosa and submucosa, with the potential to increase the risk of colorectal cancer. The global incidence of IBD is increasing, with higher rates in developed countries. UC has a significant prevalence in young adults, with similar incidence between men and women. The pathogenesis of UC involves genetic, environmental, and immunological factors. Dysregulated immune response plays a crucial role in chronic intestinal inflammation. Typical clinical presentation includes bloody diarrhea, rectal urgency, and tenesmus, with possible extraintestinal manifestations. Diagnosis is confirmed through medical history, laboratory tests, endoscopy, and biopsies. Treatment aims to achieve sustainable symptomatic and endoscopic remission, starting with aminosalicylates as first-line therapy for mild to moderate cases. Prolonged use of mesalazine may reduce the risk of colorectal cancer but also presents risks of renal toxicity. Oral corticosteroids are indicated in cases of inadequate response to initial treatment, with options such as budesonide-MMX and prednisone. In severe cases, intravenous corticosteroids, cyclosporine, and infliximab are considered. Maintenance therapy includes aminosalicylates, immunomodulators, and biological therapies. Surgery is reserved for refractory cases or emergencies, such as massive hemorrhage and toxic megacolon. The decision for surgery is made by a multidisciplinary team and depends on the patient's clinical conditions. This study provides a comprehensive understanding of the epidemiology, pathophysiology, clinical manifestations, diagnosis, treatment, and surgical considerations of UC, highlighting the importance of a multidisciplinary approach in managing this condition.