Ulcerative colitis

Bloody diarrhoea is the hallmark of acute ulcerative colitis (UC), which in most patients runs a clinical course that is characterised by unpredictable relapses interspersed with periods of remission. It can be defined as continuous mucosal inflammation of the colon without granulomas on biopsy affecting the rectum and a variable extent of the colon in continuity. Diagnostic precision is essential. The diagnosis should define the distribution and pattern of disease, because this influences treatment of both the active phase and maintenance of remission. Review of the diagnosis is fundamental when dealing with refractory symptoms or when considering surgical intervention. The potential to predict the pattern of the disease at diagnosis, or to deploy pharmacogenetics in tailoring treatment to an individual is immensely exciting. Nevertheless, technology will never remove the need for an empathetic clinician, who must first take the clinical history of miserable symptoms in a sensitive manner. © 2010 Springer-Verlag Berlin Heidelberg.