Ulcerative colitis: diagnosis

Laboratory and instrumental data

General blood analysis. For non-specific ulcerative colitis, the development of anemia of varying severity is characteristic. With massive intestinal bleeding, acute posthemorrhagic anemia develops. With a constant low blood loss in the chronic course of the disease, chronic iron deficiency anemia develops. Some patients develop autoimmune hemolytic anemia, caused by the appearance of autoantibodies to erythrocytes. In the analysis of peripheral blood, reticulocytosis appears. For acute course and exacerbation of the chronic form of ulcerative colitis, leukocytosis, a significant increase in ESR, is characteristic.

General urine analysis. In the severe course of the disease and its systemic manifestations, proteinuria and microhematuria are found.

Biochemical analysis of blood: the content of total protein, albumin is reduced, an increase in the content of a ₂ - and y-globulin is possible ; in case of liver damage, hyperbilirubinemia is observed, an increase in the activity of alanine aminotransferase; with the development of sclerosing cholangitis - y-glutamyltranspeptidase; with the development of iron deficiency anemia is characterized by a decrease in iron content.

Coprologic analysis. The degree of inflammatory-destructive process in the mucosa of the large intestine is reflected in the severity of changes in the coprocyte. For non-specific ulcerative colitis, a large number of leukocytes, erythrocytes, large accumulations of intestinal epithelial cells are found in the feces during microscopic examination. The reaction to the soluble protein in the feces (Tribula reaction) is sharply positive.

Bacteriological examination of feces reveals dysbacteriosis:

• the appearance of microorganisms of proteium, hemolyzing Escherichia, staphylococci, fungi of the genus Candida;
• the appearance in a large number of strains of Escherichia coli with weakly expressed enzymatic properties, lactonegative enterobacteria.

Macroscopically examination of feces reveals characteristic changes - a mushy or liquid character of feces, blood, a lot of mucus, pus.

Endoscopic examination (sigmoidoscopy, colonoscopy) and histological examination of colon biopsy specimens.

P. Ya. Grigoriev and AV Vdovenko (1998) describe endoscopic changes depending on the degree of severity of chronic ulcerative colitis as follows.

Light degree of severity:

• diffuse hyperemia of the mucosa;
• absence of vascular pattern;
• erosion;
• single superficial ulcers;
• localization of the pathological process mainly in the rectum.

Medium shape:

• "Granular" mucosa of the large intestine;
• easy contact bleeding;
• multiple non-ulcerative superficial ulcers of irregular shape, covered with mucus, fibrin, pus;
• localization of the pathological process mainly in the left parts of the colon.

Heavy Duty:

• pronounced necrotizing inflammation of the mucous membrane of the colon;
• severe purulent exudation;
• spontaneous hemorrhages;
• microabscesses;
• pseudopolypes;
• pathological process captures almost all parts of the colon.

Colonoscopic examination also reveals rigidity of the intestinal wall, narrowing of the large intestine.

Histological examination of biopsies reveals the presence of inflammatory infiltrates only within the mucosa and submucosa. In the early stage and the period of peptic ulcer exacerbation, inflammatory infiltrate is dominated by lymphocytes, with prolonged course - plasma cells and eosinophils. In the region of the bottom of ulcers, granulation tissue, fibrin, is found.

X-ray examination of the large intestine (irrigoscopy). Nonspecific ulcerative colitis is characterized by edema, changes in the relief (granularity) of the mucous membrane of the colon, pseudopolyposis, lack of gestation, stiffness, constriction, shortening and thickening of the intestine; ulcerative defects. Graininess of the mucosa is considered to be an early radiologic sign of nonspecific ulcerative colitis. In connection with edema, the surface of the mucous membrane becomes uneven.

In the case of toxic dilatation of the colon, irrigoscopy is not carried out because of the danger of perforation. In this situation, an overview radiograph of the abdominal cavity is recommended, and it is often possible to see stretched segments of the colon.

Differential diagnosis of ulcerative colitis

Dysentery. At the onset of development of ulcerative colitis has common features with bacterial dysentery: acute onset, diarrhea with blood, abdominal pain, fever, intoxication, and sometimes - polyarthralgia. The most important role in the diagnosis of dysentery is played by bacteriological study of feces - sowing fresh feces on differential nutrient media (shigella release is possible after 48-72 h). There are express methods for determining shigella in feces (using luminescent microscopy and coal agglomeration reaction), which allow us to conclude that there is a causative agent of dysentery within 2-3 hours.

Amoebiasis. The similarity of nonspecific ulcerative colitis and amebiasis is the presence of diarrhea with an admixture of mucus and blood, an increase in body temperature, symptoms of intoxication. The characteristic distinctive features of amebiasis are the following:

• cal in the form of "crimson jelly" (because of the admixture of blood in the stool);
• a cluster of vitreous mucus in feces in the form of "frog caviar";
• detection of tissue and histolytic form of amoeba in feces; stool should be examined no later than 10-15 minutes after defecation);
• a characteristic sigmoidoscopic picture: on the background of a small-changed mucous membrane of the large intestine, areas of hyperemia, ulcers of various sizes with pitted edges, filled with curdled necrotic masses, are revealed; on the wall and in the lumen of the large intestine a large amount of mucus, mixed with blood;
• Detection of Entamoeba histolytica in biopsy material (in necrotic masses surrounding ulcers of the mucous membrane).

Granulomatous colitis (Crohn's disease of the colon).

Ischemic colitis.

Pseudomembranous colitis.

[1], [2], [3], [4], [5], [6], [7],