Diagnosis and classification of ulcerative colitis

doi:10.1016/j.autrev.2014.01.028

Autoimmunity Reviews

Volume 13, Issues 4–5, April–May 2014, Pages 463-466

https://doi.org/10.1016/j.autrev.2014.01.028 Get rights and content

Abstract

Ulcerative colitis (UC) is a chronic relapsing inflammatory bowel disease (IBD) characterised by superficial mucosal ulceration, rectal bleeding, diarrhoea, and abdominal pain. In contrast to Crohn's disease (CrD), UC is restricted to the colon and the inflammation is limited to the mucosal layer. Classic UC affects the colon in a retrograde and continuous fashion starting from the rectum and extending proximally. Dependent on the anatomic extent of involvement, UC can be classified as proctitis, left-sided colitis, or pancolitis. Inflammatory arthropathies and primary sclerosing cholangitis (PSC) are the most common and clinically most important extraintestinal manifestations of UC. The aetiopathogenesis of UC is incompletely understood, but immune-mediated mechanisms are responsible for dysregulated immune responses against intraluminal antigens in genetically predisposed individuals. The diagnosis is based on the history, as well as clinical, radiological, endoscopic and histological features. Autoantibodies, mainly antineutrophil cytoplasmic antibodies (ANCA) and anti-goblet cell antibodies (GAB) may be helpful in the early diagnosis of UC and in differentiating it from CrD.

Introduction

Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) characterised by superficial mucosal inflammation, rectal bleeding, diarrhoea, and abdominal pain. In contrast to Crohn's disease (CrD) (see Chapter “Diagnosis and classification of Crohn's disease” in this issue), UC is usually restricted to the colon and the inflammation is limited to the mucosa.

Section snippets

Epidemiology

UC is a global disease with increasing incidence and prevalence worldwide and with different frequencies dependent on age, ethnical background and geographic localisation. Prevalence rates for UC range from 90 to 505 per 100,000 persons in Northern Europe and Northern America [1], [2], [3]. Among Caucasians the highest annual incidence of UC is 24.3 per 100,000 person-years in Europe and 19.2 per 100,000 person-years in North America [2], [3], [4]. The disease is less common in Eastern and

Activity indices

There are several UC activity indices (e.g. modified Truelove and Witts severity index or more recently the Mayo score) for classification and prognosis of UC. For clinical practice it is sufficient to describe disease activity as mild (up to four bloody stools per day), moderate (four to six bloody stools per day and minimal toxicity), or severe (more than six stools per day and signs of toxicity, such as fever, tachycardia). In fulminant colitis as the most severe form there are more than ten

Therapy

Oral aminosalicylates, either mesalazine or sulfasalazine are used for induction and maintenance of remission in mild to moderate disease [27]. Topical therapy with aminosalicylates is an alternative approach for patients with left-sided disease or proctitis. Severe or moderate UC not responding to aminosalicylates requires treatment with prednisolone (or equivalent). In patients with chronic or steroid dependent disease immunosuppressive treatment with azathioprine or 6-mercaptopurine should

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Ulcerative colitis (UC) is an idiopathic disease characterized by colonic mucosal tissue destruction secondary to an excessive immune response. We synthesized pH-sensitive cross-linked chitosan/Eudragit® S100 nanoparticles (EU S100/CS NPs) as carriers for 5-aminosalicylic acid (5-ASA) and hesperidin (HSP), then conducted in-vitro and in-vivo studies and evaluated the therapeutic effects. In-vitro analysis revealed that the 5-ASA-loaded EU S100/CS NPs and the HSP-loaded EU S100/CS NPs had smooth and curved surfaces and ranged in size between 250 and 300 nm, with a zeta potential of 32 to 34 mV. FTIR analysis demonstrated that the drugs were loaded on the nanoparticles without significant alterations. The loading capacity and encapsulation efficiency of loading 5-ASA onto EU S100/CS NPs were 25.13 % and 60.81 %, respectively. Regarding HSP, these values were 38.34 % and 77.84 %, respectively. Drug release did not occur in simulated gastric fluid (SGF), while a slow-release pattern was recorded for both drugs in simulated intestinal fluid (SIF). In-vivo macroscopic and histopathological examinations revealed that both NPs containing drugs significantly relieved the symptoms of acetic acid (AA)-induced UC in Wistar rats. We conclude that the synthesized pH-sensitive 5-ASA/EU S100/CS NPs and HSP/EU S100/CS NPs offer promise in treating UC.
The regulation of intestinal microbiota and the intervention of Chinese herbal medicine in the treatment of ulcerative colitis
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The incidence of Ulcerative colitis (UC), a key form of inflammatory bowel disease (IBD) affecting the rectum and colon, is increasing globally. The advancement in microbiome and metabolomics research has revealed the crucial involvement of the intestinal microbiota in the pathogenesis and progression of UC. Chinese herbal medicines, characterized by structural diversity and multiple pharmacological activities, consistently serve as vital sources for developing anti-UC drugs.
In this review, we searched and focused on several online databases, including the Web of Science, Science Direct, PubMed, and Google Scholar, using three keywords: “ulcerative colitis”, “intestinal microbiota”, and “Chinese herbal medicine” from 2013 to 2023. This review aims to uncover the mechanism of action of intestinal microbiota in the occurrence and development of UC and to explore the potential of Chinese herbal medicine in preventing and treating UC within the context of intestinal microbiota regulation.
This review summarizes the critical role of the intestinal microbiota in maintaining intestinal homeostasis by facilitating the repair of the intestinal epithelial cell barrier, modulating the immune system, and regulating pivotal metabolisms, including bile acids, amino acids, and short-chain fatty acids. Specifically, Chinese herbal medicines, comprising active ingredients such as polysaccharides, polyphenols, alkaloids, flavonoids, and terpenoids, as well as single Chinese herbal medicines and their extracts (extracts from Pulsatilla chinensis (Bunge) Regelcan, Ceandntella asiatica (L.) Urb., Heritiera littoralis fruit., and so on), and several combination preparations (for example, Ganluyin, Jiawei Gegen Qinlian Decoction, Baitouweng Tang), are capable of preventing and treating UC by regulating the gut flora. This, in turn, contributes to the repair of the intestinal epithelial barrier, modulation of the immune system, and regulation of those metabolisms.
Overall, our study presents a timely and comprehensive review of the regulation patterns of intestinal microbiota in the treatment of UC and the intervention of Chinese herbal medicines by modulating intestinal microbiota. This work provides a further understanding of the pathogenesis of UC and a new perspective for understanding the “multi-dimensional” means of Chinese herbal medicine in treating UC.
Ginsenoside Rg1 regulated subpopulation homeostasis of Tfh cells ameliorate experimental colitis by inhibiting TLR/MyD88 pathway
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The imbalance of follicular helper T (Tfh) cell subset is closely related to the occurrence of inflammatory bowel disease (IBD). Ginsenoside Rg1 (G-Rg1), the main component of ginseng, has excellent immunomodulatory and anti-inflammatory effects. Here, mice colitis was induced by dextran sulfate sodium and treated with G-Rg1 (200 mg/kg/day) for 14 days. Results showed that G-Rg1 can significantly alleviate symptoms of colitis in mice, regulate the balance of Tfh cell subsets, promote the secretion of IL-4 and IL-10, and inhibit the expression of IFN-γ, IL-17A, and IL-21. Molecular docking analysis revealed that G-Rg1 has excellent binding activity with target genes of the TLR/MyD88 signaling pathway, and and can reduce the expression levels of proteins such as TLR2, MyD88, IRAK4, TRAF6, and TAK1. These findings suggest that G-Rg1 can effectively regulate the balance of Tfh cell subsets, and its potential mechanism is related to the inhibition of the TLR/MyD88 signaling pathway.
Cholangiocarcinoma Surveillance Recommendations in Patients with Primary Sclerosing Cholangitis
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Association of atypical anti-neutrophil cytoplasmic antibody with comorbidities and outcome in a hospital-based population
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Atypical anti-neutrophil cytoplasmic antibody (a-ANCA) is characterized by a positive fluorescence staining other than typical cytoplasmic or perinuclear ANCA. ANCA is associated with increased risk of dialysis and mortality in patients with ANCA vasculitis. However, comorbidities related to a-ANCA and whether a-ANCA exhibits an increased risk for renal failure and mortality remain unclear. This study aimed to explore the comorbidities and outcome associated with a-ANCA.
This retrospective study enrolled 164 and 170 patients with typical ANCA and a-ANCA positivity, respectively, who visited Taichung Veterans General Hospital, Taiwan from January 2016 to March 2021. Logistic regression analysis was used to determine risk factors and the rheumatological diagnosis associated with a-ANCA. Cox proportional hazard regression and Kaplan–Meier curves were employed to identify variables associated with 5-year renal survival and mortality.
Patients with a-ANCA had lower chance of ANCA-associated vasculitis (OR: 0.02, 95 % CI: 0.01–0.07 p < 0.001), and systemic lupus erythematosus (OR: 0.23, 95 % CI: 0.11–0.48, p < 0.001), but a higher risk of rheumatoid arthritis (OR: 2.99, 95 % CI: 1.15–7.83, p = 0.025) and ulcerative colitis (OR: 5.50, 95 % CI: 1.20–25.29, p = 0.028). Patients with a-ANCA had a better renal survival (OR: 0.14, 95 % CI: 0.08–0.24, p < 0.001) and lower mortality (OR: 0.31, 95 % CI: 0.16–0.60, p = 0.001) than patents in the typical ANCA group. The 5-year renal survival and mortality was 89.3 % and 8.8 %, respectively, in patients with a-ANCA.
Patients with a-ANCA had better renal survival and lower mortality rates compared to patients with typical ANCA. These real-world data provide evidence of the long-term outcome and shed light on avenues for the strategic management of patients with a-ANCA.
Inhibition of α2,6-sialyltransferase relieves symptoms of ulcerative colitis by regulating Th17 cells polarization
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Ulcerative colitis (UC) is a chronic, relapsing inflammatory disease that affects human intestines. Immune imbalance is one of the important factors inducing UC. After the activation of CD4⁺ T cells, pro-inflammatory cytokines are produced to induce colonic inflammation. α2,6-Sialylation, catalyzed by α2,6-sialyltransferase (ST6GAL1), affects the proliferation, activation, and T cell receptor (TCR) signaling of CD4⁺ T cells, but its role in CD4⁺ T cell polarization, regulation of Th17 / Treg balance, and its role in UC are still unclear. We found the number of CD4⁺ T and Th17 cells increased in colonic tissue with UC. The level of α2,6-sialylation of CD4⁺ T cells in patients with UC was significantly increased. De-α2,6-sialylation significantly reduced the symptoms of UC in rats. ST6GAL1 gene knockout inhibited the polarization of CD4⁺ T cells to Th17 cells, and promoted the polarization of CD4⁺ T cells to Treg cells. ST6GAL1 knockout significantly inhibited the IL-17 signaling pathway in CD4⁺ T cells and inhibited the secretion of pro-inflammatory cytokine IL-17a. ST6GAL1 and IL-17a are highly expressed in patients with UC, and there is a positive correlation between them. In conclusion, reduced α2,6-sialylation inhibits the polarization of CD4⁺ T cells to Th17 cells, inhibits IL-17a signaling pathway and reduces the level of pro-inflammatory cytokine IL-17a to alleviate the symptoms of UC, which is a potential novel target for the clinical treatment of UC.

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ReviewDiagnosis and classification of ulcerative colitis

Abstract

Introduction

Section snippets

Epidemiology

Activity indices

Therapy

Autoimmun Rev

J Crohns Colitis

J Crohns Colitis

Clin Chim Acta

Gastroenterology

Gastroenterology

The changing faces of Crohn's disease and ulcerative colitis

Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review

Gastroenterology

Epidemiology of inflammatory bowel disease

Epidemiol Rev

Inflammatory bowel disease: epidemiology, pathogenesis, and therapeutic opportunities

Inflamm Bowel Dis

Genetics and pathogenesis of inflammatory bowel disease

Nature

The gut microbiota shapes intestinal immune responses during health and disease

Nat Rev Immunol

Host–microbe interactions have shaped the genetic architecture of inflammatory bowel disease

Nature

Update on the heritability of inflammatory bowel disease: the importance of twin studies

Inflamm Bowel Dis

Review
Diagnosis and classification of ulcerative colitis