The Patient with Newly Diagnosed Ulcerative Colitis

James Gregor, MD, Division of Gastroenterology, The University of Western Ontario, London, ON.
Co-authors: John Howard, MD, Nitin Khanna, MD, and Nilesh Chande, MD are members of the Division of Gastroenterology, London Health Sciences Centre, The University of Western Ontario, London, ON.

Abstract
Informed patients are one of the most important assets available in the management of patients with ulcerative colitis. Clinical experience reinforces that most patients have similar questions upon diagnosis. Anticipating these questions and tailoring them to a particular patient's disease severity and extent should not only streamline follow-up but also mitigate confusion and augment the benefit of the plethora of information available in the 21st century. Using our local experience, we have defined the 10 most common questions asked by patients and modified the answers, where necessary, to improve their specificity to patients with ulcerative proctitis, left-sided ulcerative colitis, and pancolitis.
Key words: ulcerative colitis, patient, questions, classification, management.

Introduction
Ulcerative colitis (UC) is a common gastrointestinal affliction newly diagnosed in an estimated 5,000 Canadians annually.¹ To an experienced gastroenterologist, the clinical picture, laboratory features, and endoscopic appearance, combined with histopathological confirmation, allow the diagnosis to be made quickly and accurately in most cases. Although there has been a gradual increase in available therapies in recent years, the initial treatment algorithms for most patients have not changed significantly over the past three decades.

Despite these factors, patients can remain relatively ill informed regarding the nature of the disease, its management, and its ultimate prognosis. Although some of the confusion may be attributable to mixed messages received from acquaintances and non-expert media sources, much of the failure can also be traced back to inadequate physician discussion and a lack of proper diagnostic categorization.

As with most diseases, the severity of active UC is seen across a broad spectrum, from symptoms perceived as a minor nuisance to those that are ultimately life threatening. Although most clinical scoring symptoms generally use symptoms such as stool frequency and bleeding, endoscopic severity, and effect on overall functional capacity to classify patients, disease extent is of equal and perhaps even greater value to the physician when initial treatment plans are made. Generally, disease extent is divided into three categories: ulcerative proctitis (E1), left-sided disease (E2), and pancolitis (E3) for patients in whom the disease extends proximal to the splenic flexure (Figure 1).² Although up to half of patients see a change in disease extent (either increasing or decreasing) over the decade following diagnosis, basing not only treatment but discussion on disease extent is an effective and practical approach employed by many gastroenterologists.