Regular review: Ulcerative colitis

Ulcerative colitis may present at any age, but the anatomical distribution of involvement at presentation is different between children and adults. All patients with bloody diarrhoea need to have infection excluded. Outpatient rigid sigmoidoscopy is the best method of diagnosing the nature of inflammation. The extent of inflammation may be established by total colonoscopy (or a double contrast barium enema). The mainstays of treatment are rectal and systemic 5-aminosalicylic acid derivatives and corticosteroids, with azathioprine in steroid dependent or resistant cases. Restorative proctocoiectomy with ileal pouch-anal anastomosis should be considered in every patient in whom colectomy is contemplated.