Vol. 4, Issue 3, Part G (2018)

Abstract
Ulcerative colitis is a chronic remitting inflammatory disorder of the colon involving only the mucosa and the sub mucosa. Though a disease of the developed world, recent years have seen an increase in the developing world as well. Lifestyle changes have been attributed to this current trend. However the role of genetic factors cannot be ruled out, as India heads the list with the North Indian population having prevalence almost equal to that of the Caucasians. While the exact etiopathogenesis of Ulcerative colitis still remains vague, it has been well accepted that it is a continuous inflammatory response in genetically predisposed individuals to environmental stimuli especially intraluminal antigens resulting in tissue damage. Among these factors, smoking and appendicectomy are known to play a protective role. The immunological response is a T helper 2 cell response with a possible involvement of oxidative stress. The mucosa and sub mucosa become infiltrated with acute and chronic inflammatory cells with release of various inflammatory cytokines. Erythematous and friable mucosa with pseudo polyps are a characteristic feature of ulcerative colitis. It can present with intestinal manifestations as well as with extra intestinal involvement of joints, liver, pancreas, eyes or skin. Clinically, gastrointestinal symptoms like diarrhoea, obstipation and weight loss are seen. Aminosalicylates, corticosteroids and immunosuppressants remain the mainstay of treatment for this disease. The medical treatment involves a stage of inducing remission and then maintaining this remission with the help of various drugs. Surgery is indicated in a few cases. However with better understanding of the pathology, newer drugs like anti TNFα, monoclonal antibodies, PPARγ ligand, epidermal growth factor, transdermal nicotine, short chain fatty acids and probiotics have come into the picture. Further studies and clinical trials regarding these drugs have to be done; nevertheless they hold a bright future in the management of ulcerative colitis.