Editing Ulcerative colitis (section)

==Signs and symptoms==
{{Symptoms in CD vs. UC}}

===Gastrointestinal===
People with ulcerative colitis usually present with [[diarrhea]] mixed with [[blood]],<ref name=Ungaro /> of gradual onset that persists for an extended period of time (weeks). It is estimated that 90% of people experience rectal bleeding (of varying severity), 90% experience watery or loose stools with increased stool frequency (diarrhea), and 75-90% of people experience bowel urgency.<ref name="Gros 2023" /> Additional symptoms may include fecal incontinence, mucous rectal discharge, and nocturnal defecations.<ref name=Ungaro /> With [[proctitis]] (inflammation of the rectum), people with UC may experience urgency or [[rectal tenesmus]], which is the urgent desire to evacuate the bowels but with the passage of little stool.<ref name=Ungaro /> Tenesmus may be misinterpreted as [[constipation]], due to the urge to defecate despite small volume of stool passage. Bloody diarrhea and abdominal pain may be more prominent features in severe disease.<ref name=Ungaro /> The severity of abdominal pain with UC varies from mild discomfort to very painful bowel movements and abdominal cramping.<ref name=":1">{{cite journal | vauthors = Magro F, Gionchetti P, Eliakim R, Ardizzone S, Armuzzi A, Barreiro-de Acosta M, Burisch J, Gecse KB, Hart AL, Hindryckx P, Langner C, Limdi JK, Pellino G, Zagórowicz E, Raine T, Harbord M, Rieder F | title = Third European Evidence-based Consensus on Diagnosis and Management of Ulcerative Colitis. Part 1: Definitions, Diagnosis, Extra-intestinal Manifestations, Pregnancy, Cancer Surveillance, Surgery, and Ileo-anal Pouch Disorders | journal = Journal of Crohn's & Colitis | volume = 11 | issue = 6 | pages = 649–670 | date = June 2017 | pmid = 28158501 | doi = 10.1093/ecco-jcc/jjx008 | doi-access = free }}</ref> High frequency of bowel movements, weight loss, nausea, fatigue, and fever are also common during disease flares. Chronic bleeding from the GI tract, chronic inflammation, and iron deficiency often leads to [[anemia]], which can affect quality of life.<ref name=Kaitha>{{cite journal | vauthors = Kaitha S, Bashir M, Ali T | title = Iron deficiency anemia in inflammatory bowel disease | journal = World Journal of Gastrointestinal Pathophysiology | volume = 6 | issue = 3 | pages = 62–72 | date = August 2015 | pmid = 26301120 | pmc = 4540708 | doi = 10.4291/wjgp.v6.i3.62 | doi-access = free }}</ref>

The clinical presentation of ulcerative colitis depends on the extent of the disease process.<ref name=Hanauer>{{cite journal | vauthors = Hanauer SB | title = Inflammatory bowel disease | journal = The New England Journal of Medicine | volume = 334 | issue = 13 | pages = 841–848 | date = March 1996 | pmid = 8596552 | doi = 10.1056/NEJM199603283341307 }}</ref> Up to 15% of individuals may have severe disease upon initial onset of symptoms.<ref name=Ungaro /> A substantial proportion (up to 45%) of people with a history of UC without any ongoing symptoms (clinical remission) have objective evidence of ongoing inflammation.<ref>{{cite journal | vauthors = Rosenberg L, Lawlor GO, Zenlea T, Goldsmith JD, Gifford A, Falchuk KR, Wolf JL, Cheifetz AS, Robson SC, Moss AC | title = Predictors of endoscopic inflammation in patients with ulcerative colitis in clinical remission | journal = Inflammatory Bowel Diseases | volume = 19 | issue = 4 | pages = 779–784 | date = 2013 | pmid = 23446338 | pmc = 3749843 | doi = 10.1097/MIB.0b013e3182802b0e | doi-access = free }}</ref> Ulcerative colitis is associated with a generalized inflammatory process that can affect many parts of the body. Sometimes, these associated extra-intestinal symptoms are the initial signs of the disease.<ref name=Colìa>{{cite journal | vauthors = Colìa R, Corrado A, Cantatore FP | title = Rheumatologic and extraintestinal manifestations of inflammatory bowel diseases | journal = Annals of Medicine | volume = 48 | issue = 8 | pages = 577–585 | date = December 2016 | pmid = 27310096 | doi = 10.1080/07853890.2016.1195011 | s2cid = 1796160 }}</ref>

====Extent of involvement====
[[File:Classification of Colitis.jpg|thumb|Classification of colitis, often used in defining the extent of involvement of ulcerative colitis, with proctitis (blue), proctosigmoiditis (yellow), left sided colitis (orange) and pancolitis (red). All classes extend distally to the end of the rectum.]]
[[File:Severe ulcerative colitis.jpg|thumb|Gross pathology of normal colon (left) and severe ulcerative colitis (right), forming pseudopolyps (smaller than the cobblestoning typically seen in Crohn's disease), over a continuous area (rather than skip lesions of Crohn's disease), and with a relatively gradual transition from normal colon (while Crohn's is typically more abrupt).]]
In contrast to Crohn's disease, which can affect areas of the gastrointestinal tract outside of the colon, ulcerative colitis is usually confined to the colon. Inflammation in ulcerative colitis is usually continuous, typically involving the rectum, with involvement extending proximally (to [[sigmoid colon]], ascending colon, etc.).<ref name=ACG_Guidelines_2019 /> In contrast, inflammation with Crohn's disease is often patchy, with so-called "skip lesions" (intermittent regions of inflamed bowel).<ref name="Feuerstein_Crohns">{{cite journal | vauthors = Feuerstein JD, Cheifetz AS | title = Crohn Disease: Epidemiology, Diagnosis, and Management | journal = Mayo Clinic Proceedings | volume = 92 | issue = 7 | pages = 1088–1103 | date = July 2017 | pmid = 28601423 | doi = 10.1016/j.mayocp.2017.04.010 | s2cid = 20223406 | doi-access = free }}</ref>

The disease is classified by the extent of involvement, depending on how far the disease extends:<ref name=":1" /> [[proctitis]] (rectal inflammation), left sided colitis (inflammation extending to descending colon), and extensive colitis (inflammation proximal to the descending colon).<ref name=ACG_Guidelines_2019 /> Proctosigmoiditis describes inflammation of the rectum and sigmoid colon. Pancolitis describes involvement of the entire colon, extending from the rectum to the cecum. While usually associated with Crohn's disease, [[ileitis]] (inflammation of the ileum) also occurs in UC. About 17% of individuals with UC have ileitis.<ref>{{cite journal | vauthors = Haskell H, Andrews CW, Reddy SI, Dendrinos K, Farraye FA, Stucchi AF, Becker JM, Odze RD | title = Pathologic features and clinical significance of "backwash" ileitis in ulcerative colitis | journal = The American Journal of Surgical Pathology | volume = 29 | issue = 11 | pages = 1472–1481 | date = November 2005 | pmid = 16224214 | doi = 10.1097/01.pas.0000176435.19197.88 | s2cid = 42108108 }}</ref> Ileitis more commonly occurs in the setting of pancolitis (occurring in 20% of cases of pancolitis),<ref name=Ungaro /> and tends to correlate with the activity of colitis. This so-called "backwash ileitis" can occur in 10–20% of people with [[pancolitis]] and is believed to be of little clinical significance.<ref name="ISBN 0071599916">Fauci ''et al.'' ''Harrison's Internal Medicine'', 17th ed. New York: McGraw-Hill Medical, 2008. {{ISBN|978-0-07-159991-7}}</ref>

====Severity of disease====
In addition to the extent of involvement, UC is also characterized by severity of disease.<ref name=ACG_Guidelines_2019 /> Severity of disease is defined by symptoms, objective markers of inflammation (endoscopic findings, blood tests), disease course, and the impact of the disease on day-to-day life.<ref name=ACG_Guidelines_2019 /> Most patients are categorized through endoscopy and fecal calprotectin levels. Indicators of low risk for future complications in mild and moderate UC include the following parameters: exhibiting less than 6 stools daily and lack of fever/weight loss. Other indicators include lack of extraintestinal symptoms, low levels of the inflammatory markers [[C-reactive protein]] (CRP), and [[erythrocyte sedimentation rate]] (ESR), and fecal [[calprotectin]], and later age of diagnosis (over 40 years).<ref name=":2">{{cite web |title=UpToDate |url=https://www.uptodate.com/contents/medical-management-of-low-risk-adult-patients-with-mild-to-moderate-ulcerative-colitis?search=ulcerative%20colitis&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2 |access-date=8 November 2022 |website=www.uptodate.com}}</ref> Mild disease correlates with fewer than four stools daily; in addition, mild urgency and rectal bleeding may occur intermittently.<ref name=ACG_Guidelines_2019 />  Mild disease lacks [[Systemic disease|systemic]] signs of toxicity (e.g. fever, chills, weight changes) and exhibits normal levels of the serum inflammatory markers ESR and CRP.<ref name=":2" />

Moderate to severe disease correlates with more than six stools daily, frequent bloody stools and urgency.<ref name=ACG_Guidelines_2019 /> Moderate abdominal pain, low-grade [[fever]], {{convert|38|to|39|C|F}}, and anemia may develop.<ref name=ACG_Guidelines_2019 /> ESR and CRP are usually elevated.<ref name=ACG_Guidelines_2019 />

The Mayo Score, which incorporates a combination of clinical symptoms (stool frequency and amount of rectal bleeding) with endoscopic findings and a physicians assessment of severity, is often used clinically to classify UC as mild, moderate or severe.<ref name="Gros 2023" />

Acute-Severe Ulcerative Colitis (ASUC) is a severe form which presents acutely and with severe symptoms. This fulminant type is associated with severe symptoms (usually diarrhea, rectal bleeding and abdominal pain) and is usually associated with systemic symptoms including fever.<ref name="Gros 2023" /> It is associated with a high mortality rate as compared to milder forms of UC, with a 3-month and 12 month mortality rate of 0.84% and 1% respectively.<ref name="Gros 2023" /> People with fulminant UC may have inflammation extending beyond just the mucosal layer, causing impaired colonic motility and leading to [[toxic megacolon]]. Toxic megacolon represents a medical emergency, one often treated surgically. If the [[serous membrane]] is involved, a colonic [[gastrointestinal perforation|perforation]] may ensue, which has a 50% mortality rate in people with UC.<ref>{{cite web |title=UpToDate |url=https://www.uptodate.com/contents/clinical-manifestations-diagnosis-and-prognosis-of-ulcerative-colitis-in-adults?search=clinical%20manifestation%20of%20ulcerative%20colitis&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1 |access-date=9 November 2022 |website=www.uptodate.com}}</ref> Other complications include [[hemorrhage]], [[venous thromboembolism]], and secondary infections of the colon including ''[[C. difficile]]'' or [[cytomegalovirus]] colitis.<ref name="Gros 2023" />

Ulcerative colitis may improve and enter remission.<ref name=ACG_Guidelines_2019 />

===Extraintestinal manifestations and complications===
{{Complications of CD vs. UC}}
[[File:Aphtha2.jpg|thumb|left|[[Aphthous ulcers]] involving the [[tongue]], [[lip]]s, [[palate]], and [[pharynx]].]]
[[File:Pyoderma gangrenosum 01.jpg|thumb|left|[[Pyoderma gangrenosum]] with large ulcerations affecting the back.]]
UC is characterized by immune dysregulation and systemic inflammation, which may result in [[symptom]]s and [[complication (medicine)|complications]] outside the colon. Commonly affected organs include: eyes, joints, skin, and liver.<ref name=Feuerstein_UC>{{cite journal | vauthors = Feuerstein JD, Moss AC, Farraye FA | title = Ulcerative Colitis | journal = Mayo Clinic Proceedings | volume = 94 | issue = 7 | pages = 1357–1373 | date = July 2019 | pmid = 31272578 | doi = 10.1016/j.mayocp.2019.01.018 | doi-access = free }}</ref> The frequency of such extraintestinal manifestations has been reported as between 6 and 47%.<ref name=Langan>{{cite journal | vauthors = Langan RC, Gotsch PB, Krafczyk MA, Skillinge DD | title = Ulcerative colitis: diagnosis and treatment | journal = American Family Physician | volume = 76 | issue = 9 | pages = 1323–1330 | date = November 2007 | pmid = 18019875 }}</ref><ref name=Vavricka>{{cite journal | vauthors = Vavricka SR, Schoepfer A, Scharl M, Lakatos PL, Navarini A, Rogler G | title = Extraintestinal Manifestations of Inflammatory Bowel Disease | journal = Inflammatory Bowel Diseases | volume = 21 | issue = 8 | pages = 1982–1992 | date = August 2015 | pmid = 26154136 | pmc = 4511685 | doi = 10.1097/MIB.0000000000000392 }}</ref>

UC may affect the mouth. About 8% of individuals with UC develop oral manifestations.<ref name="uhvić-Urek">{{cite journal | vauthors = Muhvić-Urek M, Tomac-Stojmenović M, Mijandrušić-Sinčić B | title = Oral pathology in inflammatory bowel disease | journal = World Journal of Gastroenterology | volume = 22 | issue = 25 | pages = 5655–5667 | date = July 2016 | pmid = 27433081 | pmc = 4932203 | doi = 10.3748/wjg.v22.i25.5655 | doi-access = free }}</ref> The two most common oral manifestations are [[aphthous stomatitis]] and [[angular cheilitis]].<ref name="uhvić-Urek"/> Aphthous stomatitis is characterized by ulcers in the mouth, which are benign, noncontagious and often recurrent. Angular chelitis is characterized by redness at the corners of the mouth, which may include painful sores or breaks in the skin.<ref name="uhvić-Urek"/> Very rarely, benign pustules may occur in the mouth (pyostomatitis vegetans).<ref name="uhvić-Urek"/>

UC may affect the eyes manifesting in scleritis, iritis, and conjunctivitis. Patients may be asymptomatic or experience redness, burning, or itching in eyes. Inflammation may occur in the interior portion of the eye, leading to [[uveitis]] and [[iritis]].<ref name=Troncoso>{{cite journal | vauthors = Troncoso LL, Biancardi AL, de Moraes HV, Zaltman C | title = Ophthalmic manifestations in patients with inflammatory bowel disease: A review | journal = World Journal of Gastroenterology | volume = 23 | issue = 32 | pages = 5836–5848 | date = August 2017 | pmid = 28932076 | pmc = 5583569 | doi = 10.3748/wjg.v23.i32.5836 | doi-access = free }}</ref> Uveitis can cause blurred vision and eye pain, especially when exposed to light ([[photophobia]]). Untreated, uveitis can lead to permanent vision loss.<ref name=Troncoso /> Inflammation may also involve the white part of the eye ([[sclera]]) or the overlying connective tissue ([[episclera]]), causing conditions called [[scleritis]] and [[episcleritis]].<ref>{{cite book | title = Episcleritis | date = January 2020 | pmid = 30521217 | last1 = Schonberg | first1 = S. | last2 = Stokkermans | first2 = T. J.|publisher=StatPearls |url=https://pubmed.ncbi.nlm.nih.gov/30521217/}}</ref> Ulcerative colitis is most commonly associated with uveitis and episcleritis.<ref name="Langholz">{{cite journal |vauthors=Langholz E |date=March 2010 |title=Current trends in inflammatory bowel disease: the natural history |journal=Therapeutic Advances in Gastroenterology |volume=3 |issue=2 |pages=77–86 |doi=10.1177/1756283X10361304 |pmc=3002570 |pmid=21180592}}</ref>

UC may cause several joint manifestations, including a type of rheumatologic disease known as [[seronegative arthritis]], which may affect few large joints (oligoarthritis), the [[Vertebral column|vertebra]] ([[ankylosing spondylitis]]) or several small joints of the hands and feet (peripheral arthritis).<ref name=Feuerstein_UC/> Often the insertion site where muscle attaches to bone ([[entheses]]) becomes inflamed ([[enthesitis]]). Inflammation may affect the [[sacroiliac joint]] ([[sacroiliitis]]).<ref name=Colìa /> It is estimated that around 50% of IBD patients suffer from migratory arthritis. Synovitis, or inflammation of the synovial fluid surrounding a joint, can occur for months and recur in later times but usually does not erode the joint. The symptoms of arthritis include [[joint pain]], swelling, and [[joint effusion|effusion]], and often leads to significant morbidity.<ref name=Colìa /> Ankylosing spondylitis and sacroilitis usually occur independent of bowel disease activity in UC.<ref name="Gros 2023" />

Ulcerative colitis may affect the skin. The most common type of skin manifestation, [[erythema nodosum]], presents in up to 3% of UC patients. It develops as raised, tender red nodules usually appearing on the outer areas of the arms or legs, especially in the anterior tibial area (shins).<ref name=Langholz /> The nodules have diameters that measure approximately 1–5&nbsp;cm. Erythema nodosum is due to inflammation of the underlying subcutaneous tissue ([[panniculitis]]), and biopsy will display focal panniculitis (although is often unnecessary in diagnosis). In contrast to joint-related manifestations, erythema nodosum often occurs alongside intestinal disease. Thus, treatment of UC can often lead to resolution of skin nodules.<ref name=":3">{{cite journal |last1=Farhi |first1=David |last2=Cosnes |first2=Jacques |last3=Zizi |first3=Nada |last4=Chosidow |first4=Olivier |last5=Seksik |first5=Philippe |last6=Beaugerie |first6=Laurent |last7=Aractingi |first7=Selim |last8=Khosrotehrani |first8=Kiarash |date=September 2008 |title=Significance of erythema nodosum and pyoderma gangrenosum in inflammatory bowel diseases: a cohort study of 2402 patients |journal=Medicine |volume=87 |issue=5 |pages=281–293 |doi=10.1097/MD.0b013e318187cc9c |issn=1536-5964 |pmid=18794711|s2cid=6905740 |doi-access=free }}</ref>

Another skin condition associated with UC is pyoderma gangrenosum, which presents as deep skin ulcerations. Pyoderma gangrenosum is seen in about 1% of patients with UC and its formation is usually independent of bowel inflammation.<ref name="Gros 2023" /> Pyoderma gangrenosum is characterized by painful lesions or [[skin condition|nodules]] that become [[ulcer (dermatology)|ulcer]]s which progressively grow. The ulcers are often filled with sterile pus-like material. In some cases, pyoderma gangrenosum may require injection with corticosteroids.<ref name="Feuerstein_UC" /> Treatment may also involve inhibitors of tumor necrosis factor (TNF), a cytokine that promotes cell survival.<ref name=":3" />

Other associations determined between the skin and ulcerative colitis include a skin condition known as [[hidradenitis suppurativa]] (HS). This condition represents a chronic process in which follicles become occluded leading to recurring inflammation of nodules and abscesses and even [[fistulas]] tunnels in the skin that drain fluid.<ref>{{cite journal |last1=Chen |first1=Wei-Ti |last2=Chi |first2=Ching-Chi |date=1 September 2019 |title=Association of Hidradenitis Suppurativa With Inflammatory Bowel Disease: A Systematic Review and Meta-analysis |journal=JAMA Dermatology |volume=155 |issue=9 |pages=1022–1027 |doi=10.1001/jamadermatol.2019.0891 |issn=2168-6084 |pmc=6625071 |pmid=31290938}}</ref>

Ulcerative colitis may affect the circulatory and endocrine system. UC increases the risk of blood clots in both arteries and veins;<ref name=Cheng_VTE>{{cite journal | vauthors = Cheng K, Faye AS | title = Venous thromboembolism in inflammatory bowel disease | journal = World Journal of Gastroenterology | volume = 26 | issue = 12 | pages = 1231–1241 | date = March 2020 | pmid = 32256013 | pmc = 7109271 | doi = 10.3748/wjg.v26.i12.1231 | s2cid = 214946656 | doi-access = free }}</ref><ref name=Nguyen_DVT>{{cite journal | vauthors = Nguyen GC, Bernstein CN, Bitton A, Chan AK, Griffiths AM, Leontiadis GI, Geerts W, Bressler B, Butzner JD, Carrier M, Chande N, Marshall JK, Williams C, Kearon C | title = Consensus statements on the risk, prevention, and treatment of venous thromboembolism in inflammatory bowel disease: Canadian Association of Gastroenterology | journal = Gastroenterology | volume = 146 | issue = 3 | pages = 835–848.e6 | date = March 2014 | pmid = 24462530 | doi = 10.1053/j.gastro.2014.01.042 }}</ref><ref>{{cite journal | vauthors = Andrade AR, Barros LL, Azevedo MF, Carlos AS, Damião AO, Sipahi AM, Leite AZ | title = Risk of thrombosis and mortality in inflammatory bowel disease | journal = Clinical and Translational Gastroenterology | volume = 9 | issue = 4 | pages = 142 | date = April 2018 | pmid = 29618721 | pmc = 5886983 | doi = 10.1038/s41424-018-0013-8 }}</ref> painful swelling of the lower legs can be a sign of [[deep venous thrombosis]], while difficulty breathing may be a result of [[pulmonary embolism]] (blood clots in the lungs). The risk of blood clots is about threefold higher in individuals with IBD.<ref name=Nguyen_DVT /> The risk of venous thromboembolism is high in ulcerative colitis due to hypercoagulability from inflammation, especially with active or extensive disease.<ref name=Cheng_VTE /> Additional risk factors may include surgery, hospitalization, pregnancy, the use of corticosteroids and tofacitinib, a JAK inhibitor.<ref name=Cheng_VTE />

[[Osteoporosis]] may occur related to systemic inflammation or prolonged steroid use in the treatment of UC, which increases the risk of bone fractures.<ref name="Colìa" /> [[Nail clubbing|Clubbing]], a deformity of the ends of the fingers, may occur.<ref name="Colìa" /> [[Amyloidosis]] may occur, especially with severe and poorly controlled disease, which usually presents with protein in the urine ([[proteinuria]]) and [[nephritic syndrome]].<ref name="Colìa" />

===Primary sclerosing cholangitis===
Ulcerative colitis (UC) has a significant association with [[primary sclerosing cholangitis]] (PSC), a progressive inflammatory disorder of small and large [[bile duct]]s. Up to 70-90% of people with primary sclerosing cholangitis have ulcerative colitis.<ref name=Langholz /> As many as 5% of people with UC may progress to develop primary sclerosing cholangitis.<ref name=Feuerstein_UC/><ref>{{cite journal | vauthors = Olsson R, Danielsson A, Järnerot G, Lindström E, Lööf L, Rolny P, Rydén BO, Tysk C, Wallerstedt S | title = Prevalence of primary sclerosing cholangitis in patients with ulcerative colitis | journal = Gastroenterology | volume = 100 | issue = 5 Pt 1 | pages = 1319–1323 | date = May 1991 | pmid = 2013375 | doi = 10.1016/0016-5085(91)90784-I }}</ref> PSC is more common in men, and often begins between 30 and 40 years of age.<ref name=Feuerstein_UC/> It can present asymptomatically or exhibit symptoms of itchiness (pruritis) and fatigue. Other symptoms include systemic signs such as fever and night sweats. Such symptoms are often associated with a bacterial episodic version of PSC. Upon physical exam, one may discern enlarged liver contours (hepatomegaly) or enlarged spleen (splenomegaly) as well as areas of excoriation. Yellow coloring of the skin, or jaundice, may also be present due to excess of bile byproduct buildup (bilirubin) from the biliary tract.

In diagnosis, lab results often reveal a pattern indicative of biliary disease (cholestatic pattern). This is often displayed by markedly elevated alkaline phosphatase levels and milder or no elevation in liver enzyme levels. Results of [[endoscopic retrograde cholangiopancreatography|endoscopic retrograde cholangiography]] (ERC) may show bile ducts with thicker walls, areas of dilation or narrowing.  However, some patients with UC and PSC have inflammation that has significantly affected only ramified [[intrahepatic bile ducts]] of smaller diameter, also known as "small ducts", which are not visualized by ERC.<ref name=rasmussen1997>{{cite journal |last1=Rasmussen |first1=H. H. |last2=Fallingborg |first2=J. F. |last3=Mortensen |first3=P. B. |last4=Vyberg |first4=M. |last5=Tage-Jensen |first5=U. |last6=Rasmussen |first6=S. N. |date=June 1997 |title=Hepatobiliary dysfunction and primary sclerosing cholangitis in patients with Crohn's disease |url=https://pubmed.ncbi.nlm.nih.gov/9200295/ |journal=Scandinavian Journal of Gastroenterology |volume=32 |issue=6 |pages=604–610 |doi=10.3109/00365529709025107 |issn=0036-5521 |pmid=9200295}}</ref>{{rp|604, 609}}

In some cases, primary sclerosing cholangitis occurs several years before the bowel symptoms of ulcerative colitis develop.<ref name="Langholz" /> PSC does not parallel the onset, extent, duration, or activity of the colonic inflammation in ulcerative colitis.<ref name="Langholz" /> In addition, colectomy does not have an impact on the course of primary sclerosing cholangitis in individuals with UC.<ref name="Langholz" /> PSC is associated with an increased risk of colorectal cancer and [[cholangiocarcinoma]] (bile duct cancer).<ref name="Langholz" /><ref name="Feuerstein_UC" /> PSC is a progressive condition, and may result in cirrhosis of the liver.<ref name="Feuerstein_UC" /> No specific therapy has been proven to affect the long-term course of PSC.<ref name="Feuerstein_UC" />