Ulcerative colitis: an update

Ulcerative colitis is a relapsing and remitting disease that is increasing in incidence and prevalence. Management aims to achieve rapid resolution of symptoms, mucosal healing and improvement in a patient?s quality of life. 5-aminosalicylate acid medications remain the first-line treatment for mild to moderate disease. In the event of suboptimal response to these medications, escalation to immunosuppressive medications and biologics may be necessary. Importantly, despite best medical therapy, surgery may be required in a proportion of patients. The future will likely see an array of new therapeutic options for those with ulcerative colitis with the potential for a more personalised treatment approach. Ulcerative colitis (UC) is a relapsing and remitting inflammatory bowel disease (IBD) characterised by mucosal inflammation which starts distally and can extend proximally to involve the whole colon. It has a reported incidence in the UK of 12.6/100,000 person years (95% confidence interval (CI) 11.4?13.9).1 Importantly, prevalence appears to be rising with the most recent data from the Lothian region highlighting a point prevalence of 432/100,000.2 UC has a bimodal age distribution with an incidence peak in the second or third decades and a second peak between 50 and 80 years. The aetiology involves interactions between the environment, immune system, gut microbiome and a genetic predisposition to disease.3 Ulcerative colitis presents with bloody diarrhoea, frequency, abdominal pain, fatigue and faecal incontinence. The Montreal classification groups UC patients, based on their