Nonspecific ulcerative colitis - Diagnosis

Laboratory and instrumental data

Complete blood count. Non-specific ulcerative colitis is characterized by the development of anemia of varying severity. Acute posthemorrhagic anemia develops with massive intestinal bleeding. Chronic iron deficiency anemia develops with constant minor blood loss during the chronic course of the disease. Some patients develop autoimmune hemolytic anemia caused by the appearance of autoantibodies to erythrocytes. In this case, reticulocytosis appears in the peripheral blood analysis. The acute course and exacerbation of the chronic form of non-specific ulcerative colitis are characterized by the development of leukocytosis and a significant increase in ESR.

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

Biochemical blood test: the content of total protein and albumin decreases, the content of a2- and y-globulins may increase _, hyperbilirubinemia and an increase in the activity of alanine aminotransferase are observed in liver damage; in the development of sclerosing cholangitis - y-glutamyl transpeptidase; in the development of iron deficiency anemia, a decrease in iron content is characteristic.

Coprological analysis. The degree of the inflammatory-destructive process in the mucous membrane of the large intestine is reflected in the severity of changes in the coprocytogram. Nonspecific ulcerative colitis is characterized by the detection of a large number of leukocytes, erythrocytes, and large clusters of intestinal epithelial cells in the feces during microscopic examination. The reaction to soluble protein in the feces (Tribule reaction) is sharply positive.

Bacteriological examination of feces reveals dysbacteriosis:

• the appearance of microorganisms such as Proteus, hemolytic Escherichia coli, staphylococci, and Candida fungi;
• the emergence of a large number of strains of E. coli with weakly expressed enzymatic properties, lactone-negative enterobacteria.

Macroscopic examination of feces reveals characteristic changes - mushy or liquid feces, blood, large amounts of mucus, pus.

Endoscopic examination (rectoscopy, colonoscopy) and histological examination of biopsies of the colon lining.

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

Mild severity:

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

Moderate form:

• "granular" mucous membrane of the large intestine;
• mild contact bleeding;
• multiple non-merging superficial ulcers of irregular shape, covered with mucus, fibrin, pus;
• localization of the pathological process mainly in the left parts of the large intestine.

Severe form:

• severe necrotizing inflammation of the colon mucosa;
• pronounced purulent exudation;
• spontaneous hemorrhages;
• microabscesses;
• pseudopolyps;
• The pathological process affects almost all parts of the large intestine.

Colonoscopy also reveals rigidity of the intestinal wall and narrowing of the colon.

Histological examination of biopsy specimens reveals the presence of inflammatory infiltrates only within the mucous membrane and submucous layer. In the early stage and exacerbation period of ulcerative colitis, lymphocytes predominate in the inflammatory infiltrate, and in the long-term course, plasma cells and eosinophils. Granulation tissue and fibrin are found in the ulcer bottom area.

X-ray examination of the colon (irrigoscopy). Non-specific ulcerative colitis is characterized by edema, changes in the relief (granularity) of the mucous membrane of the colon, pseudopolyposis, lack of haustration, rigidity, narrowing, shortening and thickening of the intestine; ulcerative defects. Granularity of the mucous membrane is considered an early X-ray sign of non-specific ulcerative colitis. Due to edema, the surface of the mucous membrane becomes uneven.

In cases of toxic dilatation of the colon, barium enema is not performed due to the risk of perforation. In this situation, plain abdominal radiography is recommended, which often allows one to see the distended segments of the colon.

Differential diagnosis of nonspecific ulcerative colitis

Dysentery. At the beginning of the development of nonspecific ulcerative colitis has common features with bacterial dysentery: acute onset, bloody diarrhea, abdominal pain, fever, intoxication, sometimes polyarthralgia. The most important role in diagnosing dysentery is played by bacteriological examination of feces - sowing fresh feces on differential nutrient media (isolation of shigella is possible after 48-72 hours). There are express methods for determining shigella in feces (using fluorescent microscopy and the reaction of coal agglomeration), allowing us to conclude about the presence of the causative agent of dysentery after 2-3 hours.

Amebiasis. The similarity between nonspecific ulcerative colitis and amebiasis is the presence of diarrhea with mucus and blood, increased body temperature, and symptoms of intoxication. The characteristic distinguishing features of amebiasis are the following:

• stool in the form of "raspberry jelly" (due to the presence of blood in the stool);
• accumulation of glassy mucus in the stool in the form of "frog spawn";
• detection of tissue and histolytic forms of amoeba in feces; feces should be examined no later than 10-15 minutes after defecation);
• characteristic rectoscopy picture: against the background of slightly changed mucous membrane of the colon, areas of hyperemia, ulcers of various sizes with undermined edges, filled with cheesy necrotic masses are revealed; on the wall and in the lumen of the colon there is 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.

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