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[[Image:UC endo 2.jpg|center|frame|200px|[[Endoscopic]] image of '''ulcerative colitis''' affecting the left side of the [[Colon (anatomy)|colon]].  The image shows confluent superficial ulceration and loss of mucosal architecture. Crohn's disease may be similar in appearance, a fact that can make diagnosing UC a challenge.]]
[[Image:UC endo 2.jpg|center|frame|200px|[[Endoscopic]] image of '''ulcerative colitis''' affecting the left side of the [[Colon (anatomy)|colon]].  The image shows confluent superficial ulceration and loss of mucosal architecture. Crohn's disease may be similar in appearance, a fact that can make diagnosing UC a challenge.]]


=== Comparison to Crohn's Disease ===
===Differentiating Crohn's disease and Ulcerative Colitis===
The most common disease that mimics the symptoms of ulcerative colitis is [[Crohn's disease]], as both are inflammatory bowel diseases that can affect the [[colon (anatomy)|colon]] with similar symptoms. It is important to differentiate these diseases, since the course of the diseases and treatments may be different. In some cases, however, it may not be possible to tell the difference, in which case the disease is classified as indeterminate colitis.<ref name="pmid28520586">{{cite journal| author=Fattahi MR, Malek-Hosseini SA, Sivandzadeh GR, Safarpour AR, Bagheri Lankarani K, Taghavi AR et al.| title=Clinical Course of Ulcerative Colitis After Liver Transplantation in Patients with Concomitant Primary Sclerosing Cholangitis and Ulcerative Colitis. | journal=Inflamm Bowel Dis | year= 2017 | volume=  | issue=  | pages=  | pmid=28520586 | doi=10.1097/MIB.0000000000001105 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28520586  }} </ref><ref name="pmid28486626">{{cite journal| author=Burisch J, Ungaro R, Vind I, Prosberg MV, Bendtsen F, Colombel JF et al.| title=Proximal disease extension in patients with limited ulcerative colitis: a Danish population-based inception cohort. | journal=J Crohns Colitis | year= 2017 | volume=  | issue=  | pages=  | pmid=28486626 | doi=10.1093/ecco-jcc/jjx066 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28486626  }} </ref><ref name="pmid25964429">{{cite journal| author=Srivastava S, Kedia S, Kumar S, Pratap Mouli V, Dhingra R, Sachdev V et al.| title=Serum human trefoil factor 3 is a biomarker for mucosal healing in ulcerative colitis patients with minimal disease activity. | journal=J Crohns Colitis | year= 2015 | volume= 9 | issue= 7 | pages= 575-9 | pmid=25964429 | doi=10.1093/ecco-jcc/jjv075 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25964429  }} </ref><ref name="pmid28505293">{{cite journal| author=Karolewska-Bochenek K, Dziekiewicz M, Banaszkiewicz A| title=Budesonide MMX in pediatric patients with ulcerative colitis. | journal=J Crohns Colitis | year= 2017 | volume=  | issue=  | pages=  | pmid=28505293 | doi=10.1093/ecco-jcc/jjx069 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28505293  }} </ref><ref name="pmid28486597">{{cite journal| author=Silva M, Cardoso H, Macedo G| title=Patency Capsule Safety in Crohn's Disease. | journal=J Crohns Colitis | year= 2017 | volume=  | issue=  | pages=  | pmid=28486597 | doi=10.1093/ecco-jcc/jjx064 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28486597  }} </ref><ref name="pmid28458507">{{cite journal| author=Stidham RW, Cross RK| title=Endoscopy and cross-sectional imaging for assessing Crohn׳s disease activity. | journal=Tech Gastrointest Endosc | year= 2016 | volume= 18 | issue= 3 | pages= 123-130 | pmid=28458507 | doi=10.1016/j.tgie.2016.08.001 | pmc=5405438 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28458507  }} </ref>
The most common disease that mimics the symptoms of Crohn's disease is [[ulcerative colitis]], as both are inflammatory bowel diseases that can affect the [[colon (anatomy)|colon]] with similar symptoms. It is important to differentiate these diseases, since the course of the diseases and treatments may be different. In some cases, however, it may not be possible to tell the difference, in which case the disease is classified as indeterminate colitis.<ref name="pmid28520586">{{cite journal| author=Fattahi MR, Malek-Hosseini SA, Sivandzadeh GR, Safarpour AR, Bagheri Lankarani K, Taghavi AR et al.| title=Clinical Course of Ulcerative Colitis After Liver Transplantation in Patients with Concomitant Primary Sclerosing Cholangitis and Ulcerative Colitis. | journal=Inflamm Bowel Dis | year= 2017 | volume=  | issue=  | pages=  | pmid=28520586 | doi=10.1097/MIB.0000000000001105 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28520586  }} </ref><ref name="pmid28486626">{{cite journal| author=Burisch J, Ungaro R, Vind I, Prosberg MV, Bendtsen F, Colombel JF et al.| title=Proximal disease extension in patients with limited ulcerative colitis: a Danish population-based inception cohort. | journal=J Crohns Colitis | year= 2017 | volume=  | issue=  | pages=  | pmid=28486626 | doi=10.1093/ecco-jcc/jjx066 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28486626  }} </ref><ref name="pmid25964429">{{cite journal| author=Srivastava S, Kedia S, Kumar S, Pratap Mouli V, Dhingra R, Sachdev V et al.| title=Serum human trefoil factor 3 is a biomarker for mucosal healing in ulcerative colitis patients with minimal disease activity. | journal=J Crohns Colitis | year= 2015 | volume= 9 | issue= 7 | pages= 575-9 | pmid=25964429 | doi=10.1093/ecco-jcc/jjv075 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25964429  }} </ref><ref name="pmid28505293">{{cite journal| author=Karolewska-Bochenek K, Dziekiewicz M, Banaszkiewicz A| title=Budesonide MMX in pediatric patients with ulcerative colitis. | journal=J Crohns Colitis | year= 2017 | volume=  | issue=  | pages=  | pmid=28505293 | doi=10.1093/ecco-jcc/jjx069 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28505293  }} </ref><ref name="pmid28486597">{{cite journal| author=Silva M, Cardoso H, Macedo G| title=Patency Capsule Safety in Crohn's Disease. | journal=J Crohns Colitis | year= 2017 | volume=  | issue=  | pages=  | pmid=28486597 | doi=10.1093/ecco-jcc/jjx064 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28486597  }} </ref><ref name="pmid28458507">{{cite journal| author=Stidham RW, Cross RK| title=Endoscopy and cross-sectional imaging for assessing Crohn׳s disease activity. | journal=Tech Gastrointest Endosc | year= 2016 | volume= 18 | issue= 3 | pages= 123-130 | pmid=28458507 | doi=10.1016/j.tgie.2016.08.001 | pmc=5405438 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28458507  }} </ref>


{| class="prettytable" cellpadding=1 style="text-align:left"
 
{| class="prettytable" cellpadding=1 style="text-align:center"
|+ '''Comparisons of various factors in Crohn's disease and ulcerative colitis'''
|+ '''Comparisons of various factors in Crohn's disease and ulcerative colitis'''
|-
|-
!  !! Crohn's Disease !! Ulcerative Colitis
!  !! Crohn's disease !! Ulcerative colitis
|-
|-
| Involves [[terminal ileum]]? || Commonly || Seldom
| '''[[Terminal ileum]] involvement''' || Commonly || Seldom
|-
|-
| Involves colon? || Usually || Always
| '''Colon involvement''' || Usually || Always  
|-
|-
| Involves rectum? || Seldom || Usually
| '''Rectum involvement''' || Seldom || Usually<ref name="Kornbluth-Sachar2004">{{cite journal | last = Kornbluth | first = Asher | coauthors = David B. Sachar | year = 2004 | month = July | title = Ulcerative Colitis Practice Guidelines in Adults | journal = American Journal of Gastroenterology | volume = 99 | issue = 7 | pages = 1371-1385 | doi = 10.1111/j.1572-0241.2004.40036.x | id = PMID 15233681 | url = http://www.acg.gi.org/physicians/guidelines/UlcerativeColitisUpdate.pdf | format = PDF | accessdate = 2006-11-08}}</ref>
|-
|-
| Peri-anal involvement? || Commonly || Seldom
| '''Involvement around the [[anus]]''' || Common<ref name="HanauerCrohns">{{cite journal | last = Hanauer | first = Stephen B. | coauthors = William Sandborn |date=March 1 2001 | title = Management of Crohn's Disease in Adults | journal=American Journal of Gastroenterology | volume = 96 | issue = 3 | pages = 635-643 | doi = 10.1111/j.1572-0241.2001.03671.x | id = PMID 11280528 | url = http://www.acg.gi.org/physicians/guidelines/CrohnsDiseaseinAdults.pdf | format = PDF | accessdate = 2006-11-08}}</ref>
|| Seldom  
|-
|-
| Bile duct involvement? || Not associated || Higher rate of [[Primary sclerosing cholangitis]]<ref>Broome U, Bergquist A. Primary sclerosing cholangitis, inflammatory bowel disease, and colon cancer. ''Semin Liver Dis'' 2006 February;26(1):31-41. PMID 16496231.</ref>
| '''Bile duct involvement''' || No increase in rate of [[primary sclerosing cholangitis]] || Higher rate<ref>{{cite journal | last = Broomé | first = Ulrika | coauthors = Annika Bergquist | year = 2006 | month = February | title = Primary sclerosing cholangitis, inflammatory bowel disease, and colon cancer | journal = Seminars in Liver Disease | volume = 26 | issue = 1 | pages = 31-41 | doi =10.1055/s-2006-933561 | id = PMID 16496231 }}</ref>
 
|-
| '''Distribution of Disease''' || Patchy areas of inflammation (Skip lesions) || Continuous area of inflammation<ref name="Kornbluth-Sachar2004"/>
|-
|-
| Distribution of Disease || Patchy areas of inflammation || Continuous area of inflammation
| '''Endoscopy''' || Deep geographic and serpiginous (snake-like) [[ulcer]]s
|| Continuous ulcer
|-
|-
| Endoscopy || Linear and serpiginous (snake-like) [[ulcer]]s
| '''Depth of inflammation''' || May be transmural, deep into tissues<ref name="HanauerCrohns"/>
  || Continuous ulcer
  || Shallow, mucosal
|-
|-
| Depth of inflammation || May be transmural, deep into tissues || Shallow, mucosal
| '''[[Fistula]]e''' || Common<ref name="HanauerCrohns"/>
|| Seldom
|-
|-
| [[Fistula]]e, abnormal passageways between organs || Commonly || Seldom
| '''[[Stenosis]]''' || Common || Seldom
|-
|-
| Biopsy || Can have [[granuloma]]ta ||  
| '''[[Autoimmunity|Autoimmune disease]]''' || Widely regarded as an autoimmune disease || No consensus
|-
|-
| Surgical cure? || Often returns following removal of affected part || Usually cured by removal of colon, can be followed by [[pouchitis]]
| '''[[Cytokine]] response''' || Associated with [[T helper cell#Th1.2FTh2 Model for helper T cells|T<sub>h</sub>1]] || Vaguely associated with T<sub>h</sub>2
|-
|-
| Smoking || Higher risk for smokers || Lower risk for smokers
| '''[[Granuloma]]s on biopsy''' || Can have granulomas<ref name="HanauerCrohns"/>
|| Granulomas uncommon<ref name="Kornbluth-Sachar2004"/>
|-
|-
| Autoimmune disease? || Generally regarded as an autoimmune disease || No consensus
| '''Surgical cure''' || Often returns following removal of affected part || Usually cured by removal of colon
|-
|-
| Cancer risk? || Lower than ulcerative colitis || Higher than Crohn's
| '''[[Tobacco smoking|Smoking]]''' || Higher risk for smokers || Lower risk for smokers<ref name="Kornbluth-Sachar2004"/>
|-
|-
|'''Risk of Cancer'''
|Lower than UC
|Higher
|}
|}


Revision as of 16:08, 19 May 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Differentiating Ulcerative Colitis from other Diseases

The following conditions may present in a similar manner as ulcerative colitis, and should be excluded:

Endoscopic image of ulcerative colitis affecting the left side of the colon. The image shows confluent superficial ulceration and loss of mucosal architecture. Crohn's disease may be similar in appearance, a fact that can make diagnosing UC a challenge.

Differentiating Crohn's disease and Ulcerative Colitis

The most common disease that mimics the symptoms of Crohn's disease is ulcerative colitis, as both are inflammatory bowel diseases that can affect the colon with similar symptoms. It is important to differentiate these diseases, since the course of the diseases and treatments may be different. In some cases, however, it may not be possible to tell the difference, in which case the disease is classified as indeterminate colitis.[1][2][3][4][5][6]


Comparisons of various factors in Crohn's disease and ulcerative colitis
Crohn's disease Ulcerative colitis
Terminal ileum involvement Commonly Seldom
Colon involvement Usually Always
Rectum involvement Seldom Usually[7]
Involvement around the anus Common[8] Seldom
Bile duct involvement No increase in rate of primary sclerosing cholangitis Higher rate[9]
Distribution of Disease Patchy areas of inflammation (Skip lesions) Continuous area of inflammation[7]
Endoscopy Deep geographic and serpiginous (snake-like) ulcers Continuous ulcer
Depth of inflammation May be transmural, deep into tissues[8] Shallow, mucosal
Fistulae Common[8] Seldom
Stenosis Common Seldom
Autoimmune disease Widely regarded as an autoimmune disease No consensus
Cytokine response Associated with Th1 Vaguely associated with Th2
Granulomas on biopsy Can have granulomas[8] Granulomas uncommon[7]
Surgical cure Often returns following removal of affected part Usually cured by removal of colon
Smoking Higher risk for smokers Lower risk for smokers[7]
Risk of Cancer Lower than UC Higher

References

  1. ↑ Fattahi MR, Malek-Hosseini SA, Sivandzadeh GR, Safarpour AR, Bagheri Lankarani K, Taghavi AR; et al. (2017). "Clinical Course of Ulcerative Colitis After Liver Transplantation in Patients with Concomitant Primary Sclerosing Cholangitis and Ulcerative Colitis". Inflamm Bowel Dis. doi:10.1097/MIB.0000000000001105. PMID 28520586.
  2. ↑ Burisch J, Ungaro R, Vind I, Prosberg MV, Bendtsen F, Colombel JF; et al. (2017). "Proximal disease extension in patients with limited ulcerative colitis: a Danish population-based inception cohort". J Crohns Colitis. doi:10.1093/ecco-jcc/jjx066. PMID 28486626.
  3. ↑ Srivastava S, Kedia S, Kumar S, Pratap Mouli V, Dhingra R, Sachdev V; et al. (2015). "Serum human trefoil factor 3 is a biomarker for mucosal healing in ulcerative colitis patients with minimal disease activity". J Crohns Colitis. 9 (7): 575–9. doi:10.1093/ecco-jcc/jjv075. PMID 25964429.
  4. ↑ Karolewska-Bochenek K, Dziekiewicz M, Banaszkiewicz A (2017). "Budesonide MMX in pediatric patients with ulcerative colitis". J Crohns Colitis. doi:10.1093/ecco-jcc/jjx069. PMID 28505293.
  5. ↑ Silva M, Cardoso H, Macedo G (2017). "Patency Capsule Safety in Crohn's Disease". J Crohns Colitis. doi:10.1093/ecco-jcc/jjx064. PMID 28486597.
  6. ↑ Stidham RW, Cross RK (2016). "Endoscopy and cross-sectional imaging for assessing Crohn׳s disease activity". Tech Gastrointest Endosc. 18 (3): 123–130. doi:10.1016/j.tgie.2016.08.001. PMC 5405438. PMID 28458507.
  7. ↑ 7.0 7.1 7.2 7.3 Kornbluth, Asher (2004). "Ulcerative Colitis Practice Guidelines in Adults" (PDF). American Journal of Gastroenterology. 99 (7): 1371–1385. doi:10.1111/j.1572-0241.2004.40036.x. PMID 15233681. Retrieved 2006-11-08. Unknown parameter |month= ignored (help); Unknown parameter |coauthors= ignored (help)
  8. ↑ 8.0 8.1 8.2 8.3 Hanauer, Stephen B. (March 1 2001). "Management of Crohn's Disease in Adults" (PDF). American Journal of Gastroenterology. 96 (3): 635–643. doi:10.1111/j.1572-0241.2001.03671.x. PMID 11280528. Retrieved 2006-11-08. Unknown parameter |coauthors= ignored (help); Check date values in: |date= (help)
  9. ↑ Broomé, Ulrika (2006). "Primary sclerosing cholangitis, inflammatory bowel disease, and colon cancer". Seminars in Liver Disease. 26 (1): 31–41. doi:10.1055/s-2006-933561. PMID 16496231. Unknown parameter |coauthors= ignored (help); Unknown parameter |month= ignored (help)

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