A Retrospective And Clinical Analysis Of Ulcerative Colitis, A Report Of 50 Cases

Background & Aim: Ulcerative colitis is a form of inflammatory bowel disease (IBD) characterized by idiopathic and chronic inflammation of the intestine. Incidence is highest in Caucasians and Jews and was considered rare in Asians. The exact etiology and pathogenesis of ulcerative colitis still remains elusive and debatable. The main symptoms are diarrhea with or without blood, abdominal pain, rectal bleeding but the symptoms vary with the race and geographical distribution and are dependent on the extent of colonic involvement and the severity of the disease. Endoscopy is the main stay for diagnosis and evaluation of the extent of the lesions in ulcerative colitis. Treatment is mainly with the 5-aminosalicylates and its derivative like sulfasalazine and mesalamine. Corticosteroids are used if the disease does not respond to the primary treatment. Refractory cases are treated with immounomodulators like Aziathropine and 6-Mercaptopurine. Though mortality rates from ulcerative colitis is low, its chronicity makes it a debilitating disease. In this study, we aim to report our experiences in the clinical features, diagnosis and treatment choices of ulcerative colitis.Methods: A retrospective and clinical analysis of 50 patients with ulcerative colitis between 2005 and 2007 was done. The diagnostic criteria was based on the guidelines for diagnosis and treatment of IBD approved in China in 2000. The clinical characteristics including sex, age, presenting complaints, investigations like hemoglobin levels, C-reactive protein levels, serological markers, colonoscopy findings like extent of the lesion and total number of days hospitalized were recorded. The study was designed to retrospectively analyze the severity of disease, its symptoms, extent of the lesions as seen on colonoscopy and treatment findings and to compare these results with similar studies done elsewhere.Results: 50 cases diagnosed with ulcerative colitis between 2005 and 2007 were taken for the study. The study group consisted of 30 females and 20 male patients. The age of presentation varied between 16 to 72 years and the mean age of presentation was 42 years. In females mean age of presentation was 41years (18-72 years) and in males 36 years (16-72 years). The peak age of prevalence of the disease was at 31-40 years with 28% (n=14) presenting in this age group. 42%(n=21) had the disease for less than 1 year. Severity of the disease was mild in 58% (n=29), moderate in18% (n=9) and severe in 24% (n=12) of the patients. Chronic disease was seen in 78%(n=39) of the patients and 22%(n=11) were admitted for the first time.The most common symptom on presentation was diarrhea in 94% (n=47). Bloody diarrhea was seen in 68% (n=34) and chronic diarrhea without blood in 26% (n=13). Abdominal pain was seen present in 68% (n=34) and tenesmus in 40% (n=20) patients. Stools were associated with pus in 22% (n=11) and/or with mucus in 28% (n=14) of the patients.The description of the lesion extent showed proctitis in 12% (n=6), proctosigmoiditis in 26% (n=13), left sided colitis in 8% (n=4), pancolitis in 30% (n=15), extensive colitis in 12%(n=6) and regional colitis in 12% (n=6). Increase in ESR and CRP was seen in 34% (n=17) and 10% (n=5) respectively. Serological markers were noted in 26% (n=13). No extraintestinal manifestations or complications were noted. The main stay of treatment was 5-Aminosalycylic acid and its derivatives given in 90% (n=45) and corticosteroids in 70%(n=35). Sulfasalazine was given as topical(enema) in 8% (n=4) and oral in 52%(n=26). Oral Mesalazine was given in 30% (n=15) of the patients. Corticosteroids such as Dexamethazone was given topical (enema) in 70% (n=35) and IV infusion in 18%(n=9). Oral Prednisilone was given 22% (n=11). Supportive treatment with antidiarrheals was given in 44% (n=22) and antibiotics in 6% (n=3) patients. Clinical remission was seen in all the patients.Conclusion: Ulcerative colitis is a relatively rare chronic disease of the large intestine. The disease affects mainly the middle aged persons and is mostly mild in presentation. Diarrhea with or without blood with abdominal pain is the most common presentation of the disease. Colonoscopy is the main diagnostic tool. The presentation of the disease is different in different parts of the world. Treatment is mainly with 5-aminosalicylates and corticosteroids. The mortality rate from the disease is very low because of the greater success rates of the medications and improved knowledge about the disease.