Ulcerative colitis other diagnostic studies: Difference between revisions
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===Colonoscopy=== | ===Colonoscopy=== | ||
Colonoscopic findings can help differentiate ulcerative colitis and Crohn's disease. Involvement of the colon and rectum and the absence of fistulas are findings that favor the diagnosis of ulcerative colitis.<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> | Colonoscopic findings can help differentiate ulcerative colitis and Crohn's disease. Involvement of the colon and rectum and the absence of fistulas are findings that favor the diagnosis of ulcerative colitis.<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> | ||
===Barium Enema=== | |||
Barium enema may be very helpful in the diagnosis of ulcerative colitis.<ref name="pmid27209295">{{cite journal| author=Boraschi P, Donati F| title=MR colonography with a fecal tagging technique and water-based enema for the assessment of inflammatory bowel disease. | journal=Jpn J Radiol | year= 2016 | volume= 34 | issue= 8 | pages= 585-94 | pmid=27209295 | doi=10.1007/s11604-016-0552-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27209295 }} </ref> | |||
===Tissue Biopsy=== | ===Tissue Biopsy=== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]
Overview
Other diagnostic studies like upper endoscopy, colonoscopy, tissue biopsy and histological analysis can help with the diagnosis of ulcerative colitis.[1]
Other Diagnostic Studies
Endoscopic
The best test for diagnosis of ulcerative colitis remains endoscopy. Full colonoscopy to the cecum and entry into the terminal ileum is attempted only if diagnosis of UC is unclear. Otherwise, a flexible sigmoidoscopy is sufficient to support the diagnosis. The physician may elect to limit the extent of the exam if severe colitis is encountered to minimize the risk of perforation of the colon. Endoscopic findings in ulcerative colitis include the following:
- Loss of the vascular appearance of the colon
- Erythema (or redness of the mucosa) and friability of the mucosa
- Superficial ulceration, which may be confluent
- Pseudopolyps
Ulcerative colitis is usually continuous from the rectum, with the rectum almost universally being involved. There is rarely peri-anal disease, but cases have been reported. The degree of involvement endoscopically ranges from proctitis or inflammation of the rectum, to left sided colitis, to pancolitis, which is inflammation involving the ascending colon.
_endoscopic_biopsy.jpg)
Colonoscopy
Colonoscopic findings can help differentiate ulcerative colitis and Crohn's disease. Involvement of the colon and rectum and the absence of fistulas are findings that favor the diagnosis of ulcerative colitis.[2]
Barium Enema
Barium enema may be very helpful in the diagnosis of ulcerative colitis.[3]
Tissue Biopsy
Biopsy shows absence of deep tissue involvement in case of ulcerative colitis. A biopsy of a patient with ulcerative colitis shows continuous involvement of the colon, lacks abscesses and granulomas.[4][1]
Histologic
Biopsies of the mucosa are taken to definitively diagnose UC and differentiate it from Crohn's disease, which is managed differently clinically. Microbiological samples are typically taken at the time of endoscopy. The pathology in ulcerative colitis typically involves distortion of crypt architecture, inflammation of crypts (cryptitis), frank crypt abscesses, and hemorrhage or inflammatory cells in the lamina propria. In cases where the clinical picture is unclear, the histomorphologic analysis often plays a pivotal role in determining the management.
References
- ↑ 1.0 1.1 Hu J, Zhao G, Zhang L, Qiao C, Di A, Gao H; et al. (2016). "Safety and therapeutic effect of mesenchymal stem cell infusion on moderate to severe ulcerative colitis". Exp Ther Med. 12 (5): 2983–2989. doi:10.3892/etm.2016.3724. PMC 5103734. PMID 27882104.
- ↑ 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) - ↑ Boraschi P, Donati F (2016). "MR colonography with a fecal tagging technique and water-based enema for the assessment of inflammatory bowel disease". Jpn J Radiol. 34 (8): 585–94. doi:10.1007/s11604-016-0552-4. PMID 27209295.
- ↑ Reinisch W, Colombel JF, D'Haens G, Sandborn WJ, Rutgeerts P, Geboes K; et al. (2017). "Characterisation of Mucosal Healing with Adalimumab Treatment in Patients with Moderately to Severely Active Crohn's Disease: Results from the EXTEND Trial". J Crohns Colitis. 11 (4): 425–434. doi:10.1093/ecco-jcc/jjw178. PMID 27815351.