A 16-year-old boy with a history of appendicitis presents with abdominal pain, malaise, weight loss, and bloody diarrhea. The nurse practitioner suspects ulcerative colitis (UC). What is the pathophysiology of UC?

Impaired lower esophageal sphincter (LES) function and transient lower esophageal sphincter relaxations (TLESRs)

Imbalance between gastric mucosal protective and destructive factors such as H. pylori infection and NSAID use

Colonic wall structure, colonic motility, diet, fiber intake, obesity and physical activity

Defects in the epithelial barrier, immune response, leukocyte recruitment, and microflora of the colon