Endoscopic Approach in Ulcerative Colitis

The term inflammatory bowel disease (IBD) is frequently used in the medical literature to define a set of diseases involving the digestive tract, particularly the small and the large intestine. The major IBDs are Crohn’s Disease (CD) and ulcerative colitis (UC). Ulcerative colitis is a chronic inflammatory disease characterized by diffuse mucosal inflammation limited to the colon. UC affects 500,000 individuals in the United States with an incidence of 12 per 100,000 per year. The lifetime risk of a severe exacerbation of UC requiring hospitalization is 15%. Patients with extensive disease (macroscopic disease proximal to the splenic flexure) are more likely to develop acute severe colitis. Approximately 4% to 9% of UC patients will require colectomy within the first year of diagnosis; the risk of colectomy following that is 1% per year. The vast majority of UC patients will require medical therapy throughout their lifetime. Ulcerative colitis, usually, involves the rectum at presentation and may extend proximally in a symmetrical, circumferential, and continuous pattern to involve parts or all of the large intestine. The disease course of UC is characterized by exacerbations and remissions, which may occur spontaneously or in response to treatment changes, superimposed infection. The diagnosis of inflammatory bowel disease is based on clinical history in combination with the results of various tests, once a single pathognomonic test allowing for a diagnostic definition is not available. Hence, the following can be cited: radiology, laboratory and hematological tests, and endoscopy combined with histology in particular.1-3 With this respect, endoscopy has revolutionized the management of patients with IBD by increasingly enabling the identification and study of lesions. Some more recent advances in endoscopic techniques can be cited, such as double-balloon enteroscopy and the capsule endoscopy, which allow for evaluating areas of the small intestine that have not been thoroughly studied to this date, in addition to digital chromoendoscopy. Improvement in IBD diagnostic capacity has direct implications in the diagnosis and followup of patients that have or are suspected to have IBD as well as in better understanding their pathogenesis, which consequently influences treatment. Great changes have occurred in IBD treatment and management in the last few decades due to the introduction of biological agents in its therapeutic arsenal. Biological therapy, represented by its major drugs – anti-TNF antibodies – has rapidly become the top of a mountain whose base is represented by other drugs that have been used in the treatment of inflammatory bowel disease for several decades.