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HIBD Horizon

Part 1 · Understanding your illness · 2/22

UC: what we know now

Ulcerative colitis: the discoveries of recent years that are changing the picture.

rectumcolon inflamed areas

Identity card

  • Where?Only the large intestine (colon). Almost always starts in the rectum.
  • How?Continuously: it spreads upwards from the rectum, with no healthy area in between.
  • How deep?Only the surface layer (the lining, or mucosa).

The bowel cut in a slice, like a tube seen end-on

inside(food)Only the inner surfaceis inflamed (in red)The rest of the wallstays healthyUsually no fistula. A stricturemust always be investigated

What has changed

1

BEFOREThe disease starts with the first bleeding.

NOWSigns can be picked up in the blood several years before diagnosis (blood tests taken a median of 7 years before), but less clearly than for Crohn's.

Gastroenterology 2025

2

BEFOREThe appendix has nothing to do with UC.

NOWIn patients in remission, removing the appendix on top of treatment reduced relapses at 1 year: 36% versus 56%. Not yet an official recommendation.

ACCURE trial, Lancet Gastroenterol Hepatol 2025

3

BEFOREIf your stools are normal, all is well.

NOWThe aim is a healed lining, even under the microscope: that is what best protects against relapses.

STRIDE international recommendations

4

BEFORELong-term treatment means an injection or an infusion.

NOWSeveral families exist as tablets (Rinvoq, Velsipity, Zeposia...) and obefazimod could follow.

European authorisations 2021-2024

5

BEFOREUC often leads to colon cancer.

NOWThe risk has fallen markedly thanks to surveillance colonoscopies and better treatments.

Large Scandinavian studies

6

BEFOREGut microbes are best left alone.

NOWFaecal microbiota transplant helps some patients in trials. It is not yet a standard treatment.

Randomised trials

7

BEFOREYou wait for the flare before acting.

NOWCalprotectin (stool test) often rises before a relapse: treatment can be adjusted earlier.

Calprotectin monitoring

8

BEFOREOne treatment works for everyone.

NOWEach treatment puts only some patients into remission (often 30 to 50%). To go further, two biologics are combined: several trials are under way.

DUET, Spyre, MORF-057 + Omvoh