Ulcerative colitis diagnosis and treatment Ulcerative colitis, or ulcerative node, is a nonspecific inflammatory bowel disease of unknown etiology that may be associated with genetics, dietary allergies, infection, autoimmunity, mental depression, and anxiety. The disease mainly involves the mucosal layer of the large intestine, and the lesions develop from the distal to the proximal rectum in a continuous manner, with the distal end being heavier than the proximal end. Clinical involvement of the rectum and sigmoid colon is common, and those with lesions confined to the rectum are called ulcerative proctitis or distal colitis. The main complications include toxic colonic dilatation and carcinoma. The disease can occur at any age, but is more common in people aged 20 to 40 years. It is common in nonsmokers. The disease has a chronic course, with an insidious onset and a prolonged course of several years to more than 10 years, often alternating between an active phase and a remitting phase. Most patients present with abdominal pain, diarrhea, and mucopurulent stools. The number of diarrhea and blood in the stool is related to the severity of the lesion: in mild cases, there are 2-4 bowel movements per day with little or no blood in the stool; in severe cases, there are more than 10 bowel movements per day with visible pus and blood. Patients are often accompanied by abdominal distension, fever, and weight loss. In patients with typical clinical manifestations, the diagnosis can be initially made by combining colonoscopy and barium enema to find continuous, erosive ulcerative inflammation of the mucosa starting in the distal colon. Clinically, it can be divided into chronic recurrent, chronic persistent, fulminant and primary types. The severity can be classified as mild, moderate or severe. The extent of the lesion can involve the rectum (>95%), the recto-big colon, the left hemicolectomy, and the whole colon. The disease stage can be divided into active and remission stage. The extraintestinal manifestations and complications include joint, skin, eye, liver and biliary system involvement; complications include hemorrhage, perforation, toxic megacolon and carcinoma. The main conditions to be differentiated are infectious diarrhea, colonic Crohn’s disease, ischemic enteritis, radiological colitis, etc. Multiple stool cultures for S. dysenteriae, non-typhoid Salmonella, Campylobacter jejuni, smears for ameba and excluding schistosomal infections are needed. Colonoscopy is the key. Endoscopy is the most direct and easiest way to diagnose ulcerative colitis. Regarding treatment treatment aims to control acute attacks, relieve symptoms, prevent complications and prevent recurrence. In mild cases, salicylic acid preparations are the mainstay, supplemented by local enemas or Chinese medicinal preparations if necessary; in severe cases, glucocorticoid drugs are required on top of salicylic acid preparations and local enemas, and immunosuppressive drugs or biological preparations are added for those who have poor results or cannot tolerate them. At the same time, systemic nutrition and symptomatic treatment should be strengthened, water-electrolyte balance should be maintained, blood and albumin should be transfused, and TPN or elemental diet should be given in severe and fulminant cases. Both active and remission phases are treated with drugs, but the types and doses of drugs are not the same. Salicylic acid preparations are the main drug. Salicylic acid preparations traditionally include salazosulfapyridine, which is a relatively inexpensive drug that needs to be decomposed by intestinal bacteria into 5-aminosalicylic acid (5-ASA) to exert therapeutic effects after oral administration. 4-6g/d of the drug is given orally in 4 doses during the exacerbation period and is changed to 2g/d for maintenance after remission. However, the drug also produces sulfonamide components when it is decomposed by bacteria, which can cause many side effects, such as headache, arthralgia, nausea, vomiting, skin rash, leukopenia, urinary tract stones, and liver function damage. The blood picture should be reviewed regularly during the course of the drug, and should be used with caution in cases of liver and kidney insufficiency. Because of the long-term medication, new aminosalicylic acid preparations without sulfonamide components, such as Sarf and Addisha, are currently advocated, but the drugs are too expensive. Overall the new salicylic acid preparations are clinically similar to SASP in terms of dosing and efficacy, but with a low incidence of side effects. In general, lifelong maintenance therapy is recommended for all patients with ulcerative colitis, especially for left-sided colitis or extensive colitis, and for patients with distal colitis that recurs more than once a year, but treatment may be discontinued for those whose ulcerative proctitis has been in remission for 2 years or who do not wish to receive this type of medication. With regard to local enema treatment, oral drugs are less effective in reaching the rectal area, and most of them may be embedded in the feces. Therefore, for patients with blood in the stool, enema treatment is more important and more effective. The enema solution mainly consists of lidocaine, metronidazole, dexamethasone, etc. The enema can also be reserved with traditional Chinese medicine such as tin type san and ice borax, bitter ginseng alkali combination. Patients can learn to take enemas at home under the guidance of their health care providers, which can facilitate treatment and save a lot of money.