ULCERATIVE COLITIS 1

ULCERATIVE COLITIS

INCIDENCE

The disease affects all age groups with highest incidence in  the

third and fourth decades.

The  average  annual  incidence rate for  ulcerative  colitis  in

whites varies from 6.5-20/1,00,000 in the west.

Incidence  of  ulcerative colitis in Jews is  about  three  times

higher and occurs more in females than in males.

Coloured races have a significantly lower incidence.

ETIOLOGY

The cause of ulcerative colitis is still uncertain.

*  There  is suspicion that allergy or hypersensitivity  plays  a

   role in the genesis of the disease.

*  Ulcerative colitis is probably a disease of  hyper-sensitivity

   or  an  autoimmune  phenomenon,  the  immune  response   being

   directed against colonic mucosa.

PATHOLOGY

Rectum  is  the  most  frequently  involved  organ  affected   by

ulcerative colitis.

*  Disease spreads proximally in more than half, the entire colon

   can be diseased.

*  The terminal ileum is involved for a short distance in 10%  of

   cases.

*  Grossly,  the serosal surface is essentially normal  early  in

   the  disease, in advanced cases, the bowel is  shortened;  the

   mesentery contracted, oedematous and thickened.

*  The  mucosal  surface in advanced chronic  ulcerative  colitis

   shows an abnormal appearance.

*  Blood and pus cover the irregular moth eaten mucosal surface.

*  There are irregular, shallow; linear ulcers intersperesed with

   islands   of  swollen  mucosa  "pseudo-polyps"   provide   the

   characteristics appearance.

HISTOLOGY

The  earliest  lesion  develops in the bases  of  the  crypts  of

Lieberkuhn,  neutrophilic  leukocytes  accumulate  in  the  crypt

lumen,  these  and eosinophis form the "crypts abscess"  and  may

rupture through the mucosal surface.

*  With progresion, numerous crypts are involved and large  areas

   of  their  walls break down, releasing the  exudate  into  the

   submucousa leading to ulceration.

*  As  the  disease  progresses  lymphocytes,  plasma  cells  and

   macrophages infiltrate the mucosa and sub-mucosa.

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