From Pathology to Treatment: Reviewing Clinical Management Strategies for Distal Ulcerative Colitis

Abstract

Background: Distal ulcerative colitis (DUC), a subtype of ulcerative colitis (UC), primarily affects the rectum and sigmoid colon. The global incidence of UC varies significantly, with the highest prevalence in North America and Europe. Peak onset occurs between ages 15–30, with a second peak at 50–70 years. Genetic susceptibility, environmental exposures, and lifestyle factors contribute to the disease burden. Notably, diagnostic and treatment approaches differ across countries, reflecting disparities in healthcare access and clinical practice. Methods: We conducted a comprehensive narrative review of recent literature on the clinical management of DUC. Databases searched included PubMed, Embase, and Google Scholar for studies published between 2015 and 2024, focusing on diagnosis, therapeutic interventions, and multidisciplinary care approaches. Results: Diagnosis is based on clinical presentation, endoscopic findings, and histopathological confirmation. First-line therapy includes topical 5-aminosalicylic acid (5-ASA) agents, with systemic therapies (oral 5-ASA, corticosteroids, immunomodulators) used for refractory disease. In moderate-to-severe cases, biologics such as anti-TNFα and anti-integrin agents are employed. Newer small-molecule therapies are emerging as promising alternatives. Long-term management includes maintenance therapy, colorectal cancer screening, and attention to psychosocial aspects such as mental health, quality of life, and patient support systems. Conclusion: Effective management of DUC requires a multidisciplinary approach integrating gastroenterological, dietary, and mental health care. Early diagnosis, individualized treatment, and adherence to evidence-based strategies are crucial for improving patient outcomes and mitigating disease burden amid persistent global disparities in care delivery.