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Epidemiology Bimodal age distribution: 1530 yrs and 5070 yrs Slight male predominance Higher prevalence in urban populations Etiology & Pathogenesis Multifactorial: genetic predisposition + immune dysregulation + environmental triggers Inflammation limited to mucosa and submucosa Begins in the rectum extends proximally (continuous lesions) Clinical Features Intestinal: Bloody diarrhea Mucus in stool Tenesmus Urgency Abdominal pain (LLQ) Systemic: Fatigue Weight loss Fever (severe disease) Extra-intestinal Manifestations Musculoskeletal: Peripheral arthritis, sacroiliitis Skin: Erythema nodosum, pyoderma gangrenosum Eyes: Uveitis, episcleritis Hepatobiliary: Primary sclerosing cholangitis (PSC) Extent (Montreal classification simplified) Proctitis rectum only Left-sided colitis up to splenic flexure Pancolitis entire colon Diagnosis Colonoscopy with biopsy gold standard Continuous erythema, friability, ulceration Histology: Crypt abscesses, mucosal inflammation Labs: ESR/CRP, anemia Exclude infection (stool cultures, C

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American College of Rheumatology