Discrete terminal ileal ulcers in patients diagnosed with ulcerative colitis: clinical significance and natural course

Background Terminal ileal (TI) ulcers are occasionally detected in asymptomatic individuals and mostly resolve without any treatment. In patients with ulcerative colitis (UC), TI ulcers are infrequently observed without evidence of backwash ileitis. However, the clinical significance and natural course of the lesions are unclear. The aim of our study was to evaluate the frequency and clinical implications of TI ulcers in patients with UC. Methods We retrospectively reviewed 397 patients with UC via successful TI intubation during colonoscopy. We compared the clinical characteristics of patients manifesting TI ulcers with those who did not. The natural course of TI lesions was also investigated during the follow-up periods. Results Forty-one patients (10.3%) showed TI ulcers without evidence of inflammation in the right colon. The patients with and without TI ulcers were not different in terms of baseline characteristics, disease activity and extent at the time of the UC diagnosis, proximal extension, Mayo endoscopic score at the last endoscopic examination, medication history, UC-related hospitalization, and relapse during follow-up periods. Of the 30 patients who underwent follow-up colonoscopy in patients with TI ulcers, 23 (76.7%) showed resolution of TI ulcer. In addition, patients with remaining TI ulcers did not differ in disease activity and biopsy results compared with those with resolving TI ulcers. Conclusions Discrete TI ulcers are more common in patients with UC, compared with the healthy cohort. No significant clinical impact on disease extension and severity is found.

Clinical Characterization of Ulcerative Colitis in Patients with Primary Sclerosing Cholangitis

Objectives. The clinical/colonoscopic features of ulcerative colitis (UC) associated with primary sclerosing cholangitis (PSC), the prognostic impact of UC, and the utility of UC screening in PSC patients are unknown. We characterized UC associated with PSC and assessed UC’s impact on the prognosis of PSC and the importance of colonoscopic UC screening in PSC patients. Methods. We retrospectively analyzed the cases of 77 patients treated for PSC at a single center (April 2000–July 2019). We reviewed the clinical/colonoscopic profiles of the concurrent UC patients and compared the clinical profiles, survival, and primary causes of death between the patients with/without UC ( n = 35 / n = 42 ). The details of all patients’ colonoscopies were reviewed. Results. The concurrent UC group: 17 men, 18 women, diagnosed with PSC at the mean (SD) age of 36 (17) years; 21 patients (60%) had no UC symptoms. Colonoscopy revealed pancolitis in all patients, predominantly affecting the right-sided colon in 30 patients (86%). Lesions were scattered. Backwash ileitis ( n = 13 , 37%) and rectal sparing ( n = 18 , 51%) were observed. Most patients had mild UC; some had moderate or more severe UC (median Ulcerative Colitis Endoscopic Index of Severity (UCEIS) score 2; range, 1–5). Ludwig’s stage determined by liver biopsy did not correlate with the Mayo endoscopic score for UC. The patients with UC were diagnosed with PSC at a significantly younger age than those without UC (mean (SD), 36 [17] years vs. 55 [19] years, p < 0.0001 ) and had a significantly higher 5-year survival rate (97.1% vs. 70.5%, p = 0.0028 ). UC was detected in 19 of 34 asymptomatic patients (56%) who underwent colonoscopy screening. Conclusions. Our cohort’s clinical/colonoscopic features of UC associated with PSC are more moderate or severe UC than previous cases. The coexistence of UC might affect the prognosis of PSC. In this regard, colonoscopy in PSC patients is an important examination for determining prognosis. There is also asymptomatic UC in patients with PSC. In this regard, screening for colonoscopy in PSC patients is essential. When a diagnosis of PSC is made, immediate colonoscopy is a priority with UC complications in mind.

Colitis ulcerosa

Zusammenfassung. Die Colitis ulcerosa ist eine chronische immunologische Darmerkrankung mit einer Entzündung der Mukosa und teilweise der Submukosa. Sie verläuft schubweise und betrifft im Gegensatz zum Morbus Crohn ausschliesslich das Kolon. Die vielzitierte Ausnahme der kurzstreckigen Beteiligung des terminalen Ileums (sogenannte backwash ileitis) ist insgesamt sehr selten und klinisch eher unbedeutend. Meist beginnt die Entzündung im Rektum und steigt im Verlauf kontinuierlich nach proximal auf. Die Erkrankung manifestiert sich mit blutig-schleimiger Diarrhö, Tenesmen und Gewichtsverlust. Die Therapie fusst auf antiinflammatorischen Substanzen sowie der Immunsuppression. Ein wichtiger und oft vernachlässigter Grundpfeiler stellt die topische Therapie mit Suppositorien, Klysmen und Schäumen von Mesalazin und Budesonid oder Hydrokortison dar. Dies vor allem, aber nicht ausschliesslich bei limitiertem Befall bis zur linken Kolonflexur. Bei schwereren Schüben bzw. ausgedehnterem Befall kommen orales Mesalazin, systemische Kortikosteroide und andere Immunsuppressiva hinzu.

Histopathological evaluation of ulcerative colitis in colonoscopic biopsies

Background: Histopathologic evaluation of colonoscopic mucosal biopsy remains one of the earliest modalities of investigation in patients clinically suspected of ulcerative colitis. Pathologists should be aware of classical histomorphological features to avoid misdiagnosis. The aim of the present study was to evaluate histopathologic features as well as to determine possible atypical presentation.Materials and Methods: Forty newly diagnosed cases of ulcerative colitis were included in the study. Colonoscopic biopsies taken from rectum as well as various areas of colon and ileum depending upon clinical extent of involvement were submitted for histopathological evaluation. Diagnosis of ulcerative colitis was made by correlating clinical, endoscopic and histopathologic findings.Results: Out of 47 cases suspected of ulcerative colitis, histopathologic features were consistent with Ulcerative colitis in 40 cases. Almost all cases (97.5%) showed diffuse active colitis. Cryptitis (100%), crypt abscesses (75%) and basal plasmacytosis (85%) along with crypt architectural abnormalities (75%) and goblet cell depletion (70%) were classical histological changes associated with ulcerative colitis in active phase. Atypical presentations noticed were focal active colitis (2.5%), backwash ileitis (2.5%), rectal sparing (2.5%) and skip areas (5%).Conclusion: Accurate diagnosis of ulcerative colitis requires elaborate knowledge of histopathologic features along with awareness of possible atypical presentation.