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Introduction
Ulcerativecolitisisaninflammatoryboweldiseaseandcanhighlyaffectapatient’slife,leadingtolong-termburdensomecomplications.Patientswithulcerativecolitismighthaveproximaldiseaseextension(untildevelopingpancolitis)ordevelopstructuralandfunctionalchanges,leadingtoimpairedqualityoflifeanddisability.Thetherapeuticoptionshaveexpandedsubstantiallyoverthepastdecadewithbiologics(eg,anti-tumournecrosisfactor(TNF),vedolizumab,andustekinumab)andsmallmolecules(eg,Januskinaseinhibitorsandsphingosine-1-receptormodulators).Therapidadventofnewtherapieshasallowedmorestringenttherapeuticgoalstobeconsidered,includingclinicalandendoscopicremission.Ongoingstudieswillfindoutwhetherhistologicalhealingcouldbetheultimatetherapeuticgoal.Onceatreatmenthasbeenintroduced,strictlymonitoringpatients,andperformingrapidtreatmentescalationifthetherapeuticgoalshavenotbeenreached,isrecommended.Despitetheseadvances,remissionratesdonotsurpass20–30%ininductionclinicaltrialsand30–60%ofpatientsinareal-lifesetting.Consequently,somepatientsstillrequiresurgeryformedicallyrefractorydisease.Althoughtotalproctocolectomywouldpotentiallycuretheinflammationofthecolon,post-operativecomplicationsarefrequent,especiallypouchitisandfaecalincontinence.Here,wereviewpracticalandup-to-dateevidenceonulcerativecolitis,whichhashadincreasedcostsofcareinthepastdecade.1
Epidemiology
Ulcerativecolitishasbecomeaglobalhealthchallengeoverthepasttwodecades,withevolvingepidemiologicaltrends.Althoughmostpopulation-basedobservationalstudiesshowthatincidenceratesareeitherstableordeclininginhigh-incomecountries,theyareincreasingsharplyinlow-incomeandmiddle-incomecountrie
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