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Update on the etiology, pathogenesis and diagnosis of ulcerative colitis

Nature Clinical Practice Gastroenterology & Hepatology volume 1, pages 26–31 (2004)Cite this article

Abstract

Evidence is accumulating that both genetic and environmental factors contribute to ulcerative colitis. The most consistent genetic associations have been shown for the MHC locus HLA Class II alleles, but the interleukin-1 family of genes and the multidrug resistance gene MDR1 have also been implicated as genetic susceptibility factors for the development of disease. In addition, there is a relationship between ulcerative colitis and bacterial flora, with an increased number of adherent Bacteroides spp. and Enterobacteriaceae spp. present in inflamed bowel segments. Conversely, cigarette smoking and appendectomy have both been shown to protect against the development of ulcerative colitis. Despite our improved understanding of the genetics and inflammatory mechanisms that underpin this disease, however, the etiology and pathogenesis of ulcerative colitis remain undefined. The diagnosis of ulcerative colitis is being aided by recent advances in diagnostic strategies, including the detection of fecal and serologic markers and the use of wireless capsule endoscopy, but, in the absence of a pathognomonic marker, the definition of this disease remains based on well-established clinical, endoscopic and histologic criteria. In particular, it is difficult to discriminate ulcerative colitis from other forms of colitis, including Crohn's disease, and there seems to be a growing overlap of pathophysiologic processes between ulcerative colitis and post-infectious irritable bowel syndrome. Patients who remain indeterminate between ulcerative colitis and Crohn's disease also continue to be a diagnostic challenge.

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Authors and Affiliations

  1. Editor-in-Chief of Nature Clinical Practice Gastroenterology & Hepatology,

    Stephen B Hanauer

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  1. Stephen B Hanauer
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Correspondence to Stephen B Hanauer.

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Competing interests

The author declares that he has received clinical research support from Abbott Labs, Ashahi, Celltech, Centocor, Elan, Genentech, Otsuka, Procter & Gamble, Protein Design Labs and Prometheus Laboratories. He has acted as a consultant for Abbott Labs, Ashahi, Celltech, Centocor, Elan, Genentech, Otsuka, Procter & Gamble, Protein Design Labs and Shire. He is a speaker for Centocor and Procter & Gamble.

Glossary

ANKYLOSING SPONDYLITIS

A degenerative inflammatory disease affecting the joints of the spine: calcification, ossification and ankylosis can cause rigidity of the spine

SACROILIITIS

Inflammation in the sacroiliac joint

ERYTHEMA NODOSUM

Red bruise-like patches caused by panniculitis that normally results from hypersensitivity (e.g. to drugs or enteropathies), but can be idiopathic

UVEITIS

Inflammation of part or all of the vascular tunic of the eye (the uvea). The sclera, cornea and retina may also be involved

DEXTRAN SULFATE

A long-chain glucose polymer that contains sulfur. It is used to induce colitis in mouse models of inflammatory bowel disease

DYSBIOSIS

An imbalance of the intestinal microbial flora that is thought to promote disease. It can be caused by parasites, fungal overgrowth, bacteria and poor diet

WIRELESS CAPSULE ENDOSCOPY

Endoscopy performed using a disposable capsule that is self-illuminating and contains a camera that can transmit images via wireless radiotransmission to an external recording device

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Hanauer, S. Update on the etiology, pathogenesis and diagnosis of ulcerative colitis. Nat Rev Gastroenterol Hepatol 1, 26–31 (2004). https://doi.org/10.1038/ncpgasthep0031

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