NON RARE IN EUROPE: Ulcerative colitis

Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) characterized by continuous inflammation and ulceration of the mucosal lining of the large intestine (colon) and rectum. The inflammation typically begins in the rectum and extends proximally in a continuous pattern, distinguishing it from Crohn's disease, which can affect any part of the gastrointestinal tract in a patchy distribution. UC primarily affects the gastrointestinal system but can also have extraintestinal manifestations involving the joints, skin, eyes, and liver (including primary sclerosing cholangitis). The disease follows a relapsing-remitting course, with periods of active inflammation (flares) alternating with periods of remission. Key symptoms include bloody diarrhea, rectal bleeding, urgency to defecate, tenesmus (a feeling of incomplete evacuation), abdominal pain and cramping, and fatigue. During severe flares, patients may experience weight loss, fever, and anemia. The severity of symptoms generally correlates with the extent of colonic involvement. Long-standing ulcerative colitis increases the risk of colorectal cancer, necessitating regular surveillance colonoscopies. The treatment landscape for ulcerative colitis includes several therapeutic approaches aimed at inducing and maintaining remission. First-line therapies include 5-aminosalicylic acid (5-ASA) compounds such as mesalazine for mild-to-moderate disease. Corticosteroids are used for acute flares but are not suitable for long-term maintenance. Immunomodulators (azathioprine, 6-mercaptopurine), biologic therapies (anti-TNF agents such as infliximab and adalimumab, anti-integrin agents such as vedolizumab, and anti-IL-12/23 agents such as ustekinumab), and Janus kinase (JAK) inhibitors (tofacitinib, upadacitinib) are used for moderate-to-severe disease. Surgical intervention with proctocolectomy and ileal pouch-anal anastomosis (IPAA) remains a curative option for refractory cases or when complications such as dysplasia or cancer arise.

Data sourced from FDA regulatory filings and ClinicalTrials.gov. Updated periodically.

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