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What Is Ulcerative Colitis?

Aphthous Ulcer

Patients with ulcerative colitis can occasionally have aphthous ulcers involving the tongue, lips, palate and pharynx.

Ulcerative colitis is a form of inflammatory bowel disease (IBD). It is a disease of the intestine, specifically the large intestine or colon, that includes characteristic ulcers, or open sores, in the colon. The main symptom of active disease is usually diarrhea mixed with blood, of gradual onset. Other symptoms include weight loss and different degrees of abdominal pain, from mild discomfort to severely painful cramps.

Because of the name, IBD is often confused with irritable bowel syndrome ("IBS"), a troublesome, but much less serious condition.

As ulcerative colitis is a systemic disease, patients may present with symptoms and complications outside the colon. These include the following:

  • Aphthous ulcers of the mouth
  • Ophthalmic (involving the eyes):
    • Iritis or uveitis, which is inflammation of the iris
    • Episcleritis
  • Musculoskeletal:
    • Seronegative arthritis, which can be a large-joint oligoarthritis (affecting one or two joints), or may affect many small joints of the hands and feet
    • Ankylosing spondylitis, arthritis of the spine
    • Sacroiliitis, arthritis of the lower spine
  • Cutaneous (related to the skin):
    • Erythema nodosum, which is a panniculitis, or inflammation of subcutaneous tissue involving the lower extremities
    • Pyoderma gangrenosum, which is a painful ulcerating lesion involving the skin
  • Deep venous thrombosis and pulmonary embolism
  • Autoimmune hemolytic anemia
  • Clubbing, a deformity of the ends of the fingers
  • Primary sclerosing cholangitis, or inflammation of the bile ducts

Ulcerative colitis is an intermittent disease, with periods of exacerbated symptoms, and periods that are relatively symptom-free. Although the symptoms of ulcerative colitis can sometimes diminish on their own, the disease usually requires treatment to go into remission.

The disease is rare, with an incidence of about one person per 10,000 in North America.

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