A Step Forward in the Understanding of Structural and Functional Bowel Damage in Patients with Ulcerative Colitis

pitalization and surgery, or development of dysplasia, are the usual complications of UC. However, long-lasting UC, where recurrent bouts of inflammation are allowed to progress, can potentially have devastating consequences in colonic and rectal physiology, as supported by some evidence [3]. For example, it is well known that chronic UC can be complicated by benign strictures and colon shortening and narrowing, with nefarious consequences on colonic motility [4]. Additionally, fibrosis has also been reported to exist in UC, and benign strictures, although less common than in CD, are also a possible complication of the disease [5]. Additional complications of the disease that could be considered as progression are disease-proximal extension (disease progressing from proctitis or left-sided colitis to more extensive forms of inflammation) and pseudopolyps [3]. Finally, one of the largely unexplored consequences of chronic UC relates to its potential to affect anorectal and colonic function. Severe rectal inflammation, not adequately and timely treated, can result in rectal narrowing and presacral space widening, with impairment in rectal compliance, resulting in distressful complaints of fecal incontinence, urgency, and tenesmus [6]. Likewise, many studies, mostly performed in the past, have shown that UC is characterized by decreased contractility and a reduction in the pressure or amplitude of segmental contractions, which has been hypothesized to be a consequence of wall stiffness [7]. The