Ulcerative Colitis: Clinical Features, Diagnosis, and Evolving Therapeutic Strategies

Zhaohengyi Li

doi:10.54097/eyhfaj26

Authors

Zhaohengyi Li

DOI:

https://doi.org/10.54097/eyhfaj26

Keywords:

Ulcerative Colitis, Inflammatory Bowel Disease, Biologics, Treat-to-target, Mucosal Healing

Abstract

Ulcerative colitis (UC) is a chronic inflammatory bowel disease characterised by relapsing–remitting colonic inflammation, extra-intestinal manifestations, and substantial impairment in quality of life. This narrative review summarises current understanding of clinical phenotypes, diagnostic strategies, and therapeutic approaches in UC. Clinically, rectal bleeding, diarrhoea, urgency, and abdominal pain predominate, while arthritis, primary sclerosing cholangitis, and thromboembolism contribute to systemic morbidity. Diagnosis relies on integration of symptoms, biomarkers, endoscopy, and histology; colonoscopy with systematic biopsies remains the cornerstone, complemented by faecal calprotectin, C-reactive protein, and early histological markers such as basal plasmacytosis. Treatment follows a stepwise, treat-to-target strategy aiming for durable, steroid-free clinical and endoscopic remission. Mesalazine is first-line for mild-to-moderate disease, with corticosteroids for flares and thiopurines or other immunomodulators for steroid-dependent phenotypes. In moderate-to-severe or refractory UC, biologics and small-molecule agents, including anti-TNF therapy, vedolizumab, ustekinumab, JAK inhibitors, and S1P receptor modulators, which have reduced colectomy rates, while surgery remains essential for complications and medical failure. Future directions include precision diagnostics, microbiome-based interventions, and bile acid receptor–targeted therapies.

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