Correlation between clinical activity, endoscopic severity & lab parameters in ulcerative colitis.

INTRODUCTION : Ulcerative colitis (UC) is a chronic inflammatory disease of the bowel, characterized by multiple relapses & remission ,which leads to significant morbidity and health care cost and is also challenging to the treating gastroenterologist. All chronic diarrhoea and rectal bleeding during the year 1960’s were diagnosed as amoebic colitis or infective diarrhoea. Ulcerative colitis in India was first reported by Tandon and Chuttani et al. Various studies from India as well as from south India cites the increasing trends in ulcerative colitis. UC affects the mucosal layer of the colon and produces multiple ulcerations, diffuse inflammation and desquamation of the colonic epithelium. The etiology of UC is unknown; however, genetic, immunologic, and environmental factors has a role in the pathogenesis of UC. The disease had a bimodal distribution. Both young adults & elderly individuals are at risk for developing this disorder. The clinical presentations in UC varies, in severity, extent of disease, presence of extraintestinal manifestations & response to therapy. It was found that 9% have severe, 71% have moderate & 20% of patients with mild disease activity at the time of presentation. Diagnosis of UC is based on clinical, endoscopic and histopathological findings. Mucosal assessment by colonoscopy is the best option in the diagnosis of ulcerative colitis . Newer diagnostic tools like chromoendoscopy, NBI, EUS have a definite role in the management of UC. Severity of the disease is determined by assessing clinical symptoms, elevation in ESR or CRP & by fecal calprotectin. Dysplasia, colorectal malignancy, fulminant colitis were some of the feared complications of UC. AIM AND OBJECTIVES : 1. To evaluate whether the clinlcal disease severity in ulcerative colitis and lab parameters reflect the degree of endoscopic activity. 2. To asses whether endoscopic findings during remission predicts the future clinical disease pattern. CONCLUSION : This study fails to show a bimodal age distribution in UC. On the basis of Truelove and Witts classification majority had a mild disease. Proctitis was the commonest colonoscopic finding in this study. Mild clinical disease was associated with distal colitis and severe disease was found to have either extensive or pancolitis. Nocturnal diarrhea and fever were observed more commonly in patients who had maximum disease activity in the proximal colon compared with the rectum or sigmoid. CRP elevation reflects the activity of proximal lesions. In patients with mild to moderate disease none of the patients had a complete mucosal healing response with sulphasalazine therapy at 3 and 6 months respectievely .Sulphasalazine 4 grams may be a suboptimal dose.