Ulcerative colitis classification: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Ulcerative colitis}} | {{Ulcerative colitis}} | ||
{{CMG}} | {{CMG}}; {{AE}}{{USAMA}} | ||
==Overview== | ==Overview== | ||
Inflammatory bowel disease ([[IBD]]) may be classified into ulcerative colitis and [[Crohn's disease]]. Some cases which depict overlapping features of both ulcerative colitis and [[Crohn's disease]] can be classified as intermediate colitis. Ulcerative colitis may be classified according to [[anatomical]] location as proximal or distal. Additionally, ulcerative colitis may be classified based on the severity into mild, moderate, severe or fulminant.<ref name="pmid20068560">{{cite journal| author=Kornbluth A, Sachar DB, Practice Parameters Committee of the American College of Gastroenterology| title=Ulcerative colitis practice guidelines in adults: American College Of Gastroenterology, Practice Parameters Committee. | journal=Am J Gastroenterol | year= 2010 | volume= 105 | issue= 3 | pages= 501-23; quiz 524 | pmid=20068560 | doi=10.1038/ajg.2009.727 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20068560 }} </ref> | |||
==Classification== | ==Classification== | ||
The inflammatory bowel disease ([[IBD]]) is divided primarily into | The inflammatory bowel disease ([[IBD]]) is divided primarily into ulcerative colitis and [[Crohn's disease]]. Ulcerative colitis can be classified on according to anatomical location or severity.<ref name="pmid20068560">{{cite journal| author=Kornbluth A, Sachar DB, Practice Parameters Committee of the American College of Gastroenterology| title=Ulcerative colitis practice guidelines in adults: American College Of Gastroenterology, Practice Parameters Committee. | journal=Am J Gastroenterol | year= 2010 | volume= 105 | issue= 3 | pages= 501-23; quiz 524 | pmid=20068560 | doi=10.1038/ajg.2009.727 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20068560 }} </ref><ref name="pmid28440311">{{cite journal| author=Zhao X, Zhou C, Ma J, Zhu Y, Sun M, Wang P et al.| title=Efficacy and safety of rectal 5-aminosalicylic acid versus corticosteroids in active distal ulcerative colitis: a systematic review and network meta-analysis. | journal=Sci Rep | year= 2017 | volume= 7 | issue= | pages= 46693 | pmid=28440311 | doi=10.1038/srep46693 | pmc=5404224 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28440311 }} </ref><ref name="pmid27916678">{{cite journal| author=Fumery M, Dulai PS, Gupta S, Prokop LJ, Ramamoorthy S, Sandborn WJ et al.| title=Incidence, Risk Factors, and Outcomes of Colorectal Cancer in Patients With Ulcerative Colitis With Low-Grade Dysplasia: A Systematic Review and Meta-analysis. | journal=Clin Gastroenterol Hepatol | year= 2017 | volume= 15 | issue= 5 | pages= 665-674.e5 | pmid=27916678 | doi=10.1016/j.cgh.2016.11.025 | pmc=5401779 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27916678 }} </ref><ref name="pmid28494754">{{cite journal| author=Tran DH, Wang J, Ha C, Ho W, Mattai SA, Oikonomopoulos A et al.| title=Circulating cathelicidin levels correlate with mucosal disease activity in ulcerative colitis, risk of intestinal stricture in Crohn's disease, and clinical prognosis in inflammatory bowel disease. | journal=BMC Gastroenterol | year= 2017 | volume= 17 | issue= 1 | pages= 63 | pmid=28494754 | doi=10.1186/s12876-017-0619-4 | pmc=5427565 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28494754 }} </ref> | ||
===Classification of Ulcerate Colitis based on Location=== | |||
Ulcerative colitis can be classified as follows based on the location of involvement of the colon: | |||
*'''Distal''' | |||
**Limited below the [[descending colon]] | |||
**[[Topical]] therapy can be used | |||
*'''Proximal''' | |||
**Extends proximal to the [[descending colon]] | |||
**Systemic therapy is required | |||
===Classification of Ulcerate Colitis based on Severity=== | |||
*'''Mild''' | |||
**< 4 loose [[stools]] per day (+/- blood) | |||
**No [[dehydration]] | |||
**Mild crampy [[pain]] | |||
**No [[fever]] | |||
**Normal [[hemoglobin]] | |||
**Normal [[ESR]] | |||
*'''Moderate''' | |||
**> 4 loose [[stools]] per day (+/- blood) | |||
**Mild [[dehydration]] | |||
**[[Abdominal pain]] that is not severe | |||
**Low grade [[fever]] | |||
**Mild [[anemia]] not requiring blood transfusions | |||
*'''Severe''' | |||
**≥6 loose bloody [[stools]] per day | |||
**Moderate to severe [[dehydration]] | |||
**Severe abdominal [[cramps]] | |||
**High [[fever]] ([[temperature]] ≥37.5ºC) | |||
**HR ≥90 beats/minute | |||
**[[Hemoglobin]] <10.5 g/dL | |||
**Elevated ESR (≥30 mm/hour) | |||
**Rapid weight loss | |||
*'''Fulminant''' | |||
**>10 loose [[stools]] per day | |||
**Continuous [[bleeding]] | |||
**Severe [[dehydration]] | |||
**Severe [[abdominal pain]] | |||
**[[Abdominal distension]] | |||
**High [[fever]] (temperature ≥37.5ºC) | |||
**HR ≥90 beats/minute | |||
**[[Hemoglobin]] <10.5 g/dL | |||
**Elevated [[ESR]] (≥30 mm/hour) | |||
**Rapid weight loss | |||
== References == | == References == | ||
{{Reflist|2}} | {{Reflist|2}} | ||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
Latest revision as of 14:29, 14 June 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]
Overview
Inflammatory bowel disease (IBD) may be classified into ulcerative colitis and Crohn's disease. Some cases which depict overlapping features of both ulcerative colitis and Crohn's disease can be classified as intermediate colitis. Ulcerative colitis may be classified according to anatomical location as proximal or distal. Additionally, ulcerative colitis may be classified based on the severity into mild, moderate, severe or fulminant.[1]
Classification
The inflammatory bowel disease (IBD) is divided primarily into ulcerative colitis and Crohn's disease. Ulcerative colitis can be classified on according to anatomical location or severity.[1][2][3][4]
Classification of Ulcerate Colitis based on Location
Ulcerative colitis can be classified as follows based on the location of involvement of the colon:
- Distal
- Limited below the descending colon
- Topical therapy can be used
- Proximal
- Extends proximal to the descending colon
- Systemic therapy is required
Classification of Ulcerate Colitis based on Severity
- Mild
- < 4 loose stools per day (+/- blood)
- No dehydration
- Mild crampy pain
- No fever
- Normal hemoglobin
- Normal ESR
- Moderate
- > 4 loose stools per day (+/- blood)
- Mild dehydration
- Abdominal pain that is not severe
- Low grade fever
- Mild anemia not requiring blood transfusions
- Severe
- ≥6 loose bloody stools per day
- Moderate to severe dehydration
- Severe abdominal cramps
- High fever (temperature ≥37.5ºC)
- HR ≥90 beats/minute
- Hemoglobin <10.5 g/dL
- Elevated ESR (≥30 mm/hour)
- Rapid weight loss
- Fulminant
- >10 loose stools per day
- Continuous bleeding
- Severe dehydration
- Severe abdominal pain
- Abdominal distension
- High fever (temperature ≥37.5ºC)
- HR ≥90 beats/minute
- Hemoglobin <10.5 g/dL
- Elevated ESR (≥30 mm/hour)
- Rapid weight loss
References
- ↑ 1.0 1.1 Kornbluth A, Sachar DB, Practice Parameters Committee of the American College of Gastroenterology (2010). "Ulcerative colitis practice guidelines in adults: American College Of Gastroenterology, Practice Parameters Committee". Am J Gastroenterol. 105 (3): 501–23, quiz 524. doi:10.1038/ajg.2009.727. PMID 20068560.
- ↑ Zhao X, Zhou C, Ma J, Zhu Y, Sun M, Wang P; et al. (2017). "Efficacy and safety of rectal 5-aminosalicylic acid versus corticosteroids in active distal ulcerative colitis: a systematic review and network meta-analysis". Sci Rep. 7: 46693. doi:10.1038/srep46693. PMC 5404224. PMID 28440311.
- ↑ Fumery M, Dulai PS, Gupta S, Prokop LJ, Ramamoorthy S, Sandborn WJ; et al. (2017). "Incidence, Risk Factors, and Outcomes of Colorectal Cancer in Patients With Ulcerative Colitis With Low-Grade Dysplasia: A Systematic Review and Meta-analysis". Clin Gastroenterol Hepatol. 15 (5): 665–674.e5. doi:10.1016/j.cgh.2016.11.025. PMC 5401779. PMID 27916678.
- ↑ Tran DH, Wang J, Ha C, Ho W, Mattai SA, Oikonomopoulos A; et al. (2017). "Circulating cathelicidin levels correlate with mucosal disease activity in ulcerative colitis, risk of intestinal stricture in Crohn's disease, and clinical prognosis in inflammatory bowel disease". BMC Gastroenterol. 17 (1): 63. doi:10.1186/s12876-017-0619-4. PMC 5427565. PMID 28494754.