The inflammatory bowel diseases (IBD) – ulcerative colitis and Crohn’s disease – constitute a group of disorders of the small and large intestine whose causes and interrelationships remain obscure (Kirsner and Shorter 1988). Their course is acute and chronic, with unpredictable remissions and exacerbations, and numerous local and systemic complications. Treatment is symptomatic and supportive. The economic drain imposed by these diseases in terms of direct medical, surgical, and hospitalization expenses, loss of work, and interrupted career development is enormous. The emotional impact upon the patient and upon the family is equally substantial. In these contexts, the inflammatory bowel diseases today are one of the major worldwide challenges in medicine.

Ulcerative Colitis

Clinical Manifestations, Pathology, and Diagnosis

The principal symptoms of ulcerative colitis are rectal bleeding, constipation early (in ulcerative proctitis), diarrhea usually, abdominal cramping pain, rectal urgency, fever, anorexia, fatigue, and weight loss. The physical findings depend upon the severity of the colitis, ranging from normal in mild disease, to fever, pallor from loss of blood, dehydration and malnutrition, and the signs of associated complications. X-ray and endoscopic examinations demonstrate diffuse inflammation and ulceration of the rectum and colon in 50 percent of patients, and the adjoining terminal ileum. Ulcerative colitis begins in the mucosa and submucosa of the colon (the inner bowel surface); in severe colitis the entire bowel wall may be involved. The principal histological features are the following: vascular congestion, diffuse cellular infiltration with polymorphonuclear cells, lymphocytes, plasma cells, mast cells, eosinophils, and macrophages; multiple crypt abscesses; and shallow ulcerations. Chronic ulcerative proctits is the same disease as ulcerative colitis, except for its restriction to the rectum and its milder course.