溃疡性结肠炎的临床表现与鉴别诊断

溃疡性结肠炎(ulcerative colitis,UC)是一种原因不明的大肠粘膜的慢性炎症和溃疡性病变.其临床表现多样化,诊断缺乏特异性.因此,掌握本病的临床表现和鉴别诊断具有十分重要的意义.     

溃疡性结肠炎发病机制及其诊断

溃疡性结肠炎是一病因未明的非特异性慢性结肠炎症性疾病,目前已知遗传、环境和感染、免疫因素与该病的发生和发展有关。该病的规范化诊断十分重要,强调临床、内镜、组织学、影像学以及其他检查的综合性诊断及排除性诊断。利用一切可靠的常规和新的诊断方法,排除病因可查的结肠炎,特别是感染性结肠炎。对初发病例,临床表现和结肠镜改变均不典型者,需要随访。注重全面评估疾病的分型、分布、严重和活动性及并发症,作为治疗选择与预后判断的依据。     

溃疡性结肠炎的X线和肠镜检查

溃疡性结肠炎(UC)目前尚无诊断的"金标准",主要根据临床表现,X线胃肠造影、内镜检查和病理检查结果综合判断,且需排除其他疾病[1],因此,X线和肠镜检查在UC的诊断中有非常重要的作用.     

内镜结合病理检查在溃疡性结肠炎和克罗恩病鉴别诊断中的价值

目的评价内镜及病理检查在溃疡性结肠炎和克罗恩病鉴别诊断中的价值.方法回顾性分析161例溃疡性结肠炎和89例克罗恩病的临床资料,对其病变分布、内镜结果及病理检查进行了分析.结果克罗恩病好发于末段回肠、右半结肠及上消化道,而溃疡性结肠炎好发于直肠.克罗恩病的病理特征有非干酪样肉芽肿、裂隙样溃疡、淋巴细胞聚集、全层炎;溃疡性结肠炎的病理学特征有弥漫性或灶性黏膜炎症、隐窝脓肿、黏膜糜烂及溃疡.结论内镜结合病理检查在溃疡性结肠炎和克罗恩病鉴别诊断中起到决定性作用,尤其手术标本的病理检查对CD诊断价值较大.     

联动成像技术在溃疡性结肠炎中的诊治价值

既往溃疡性结肠炎的治疗目标仅限于临床缓解、内镜缓解, 近年来组织学缓解已经成为其治疗的终极目标, 因此, 在诊疗过程中, 内镜与组织学具有良好的相关性尤为重要。蓝光内镜联动成像模式增强了病变黏膜与正常黏膜的颜色对比度, 为溃疡性结肠炎的精确诊疗带来更多可能性。本文将对联动成像技术在溃疡性结肠炎诊断及预后中的研究进展进行阐述。     

高龄初发溃疡性结肠炎1例

溃疡性结肠炎是一种慢性非特异性肠道炎性疾病,其病因尚未明确,临床表现为持续或反复发作的腹泻、黏液脓血便伴腹痛、里急后重和不同程度的全身症状。我国炎症性肠病诊断治疗规范的共识意见指出,溃疡性结肠炎最常发生于青壮年期,但是欧美流行病学家认为溃疡性结肠炎存在青年和老年两个不同年龄段的发病高峰。本文报道了1位高龄既往无相关病史首次发作的溃疡性结肠炎患者的诊治经过。     

溃疡性结肠炎并发坏疽性脓皮病的诊治护理1例

溃疡性结肠炎并发坏疽性脓皮病临床较为罕见.现报道1例男性患者,由门诊以肛瘘收入院,行肛瘘术中发现指套染有脓血,术后出现发热、脓血便、腹部溃疡面迅速扩大,行电子结肠镜检查并取活检诊断为溃疡性直肠炎,取皮肤组织病理并综合临床表现诊断为坏疽性脓皮病,经创面护理、美沙拉嗪及激素治疗44 d后腹部溃疡面趋于愈合,病情好转出院.由于溃疡性结肠炎并发的坏疽性脓皮病其临床表现及病理变化无特异性,导致早期诊断较为困难,且该病进展迅速、损害严重,应引起广大医护人员重视.     

未定型炎症性肠病

溃疡性结肠炎（UC）和克罗恩病（CD）的诊断和鉴别诊断非常重要,但临床上两者的诊断和鉴别诊断却十分困难,甚至无法区分.于是,有学者提出了＂未定型炎症性肠病（IBDU）＂这一概念来定义无法区分UC和CD的情况.不过,这一概念一经提出就引起了很大的争议,有关它的定义、临床表现、内镜特点及病理特征等都存在不少分歧.     

溃疡性结肠炎的发展与肝硬脂酰CoA去饱和酶1的关系

<正>溃疡性结肠炎(ulcerative colitis,UC)是一种发生在胃肠道的慢性非特异性UC。临床主要表现为腹泻、黏液便、脓血便、腹痛、里急后重等;其特点是症状反复发作,迁延不愈,严重影响患者生活质量。UC的发病机制不明确,目前诊断主要依靠临床表现、内镜、组织学、影像学和实验室检查。但是由于缺乏灵敏性和特异性高的诊断指标,疾病处于进展期的诊断往往延迟[1-2]。UC的发病存在东西方差     

李任先教授治疗溃疡性结肠炎经验

溃疡性结肠炎 ,又名非特异性溃疡性结肠炎 ,世界卫生组织称为特发性结肠炎 ,是一种以腹痛、腹泻、粘液便、血便为主要临床表现的非特异性炎症性结肠疾病。本病多发于 2 0岁～ 40岁的青壮年 ,随着饮食结构、生活习惯和生活节奏的改变以及诊断水平的提高 ,近年来中、老年发病有上升趋势。本病病因目前尚不明确 ,国内外文献报道对本病尚无特效疗法 ,且易复发。中医文献虽无溃疡性结肠炎的病名 ,但从其临床症候特点来看 ,当属泄泻、肠风、下血、休息痢、肠癖等病证范畴。李任先教授从事中医临床 40余载 ,治学严谨 ,于溃疡性结肠炎的临证治疗具有…     

Ulcerative colitis associated enteritis: is ulcerative colitis always confined to the colon?

Ulcerative colitis (UC) is a chronic inflammatory disease of the colon whose etiology is unknown. Small bowel involvement in UC is extraordinarily rare, and should make the clinician question the diagnosis. However, we present a case of a 38-year-old man with voluminous diarrhea following colectomy for well-documented UC; he was found to have ulcerative enteritis with histologic features identical to UC. Also, for the first time, we present an inclusive review of another 11 cases of UC associated enteritis (UCAE) reported in the literature, and discuss the significance of the entity. We conclude that UC is rarely accompanied by enteritis that is distinct from Crohn disease, frequently presents shortly after colectomy, and usually is responsive to traditional therapies for inflammatory bowel disease (IBD).     

Sternocostal involvement in chronic recurrent multifocal osteomyelitis associated with ulcerative colitis

Chronic recurrent multifocal osteomyelitis (CRMO) is a chronic, relapsing, inflammatory, non-infectious disorder of the skeletal system and is of unknown origin. Early diagnosis of the disease is essential to exact treatment. The relationship between inflammatory bowel disease and CRMO is understood as extraintestinal rheumatic manifestations. CRMO associated with ulcerative colitis (UC) is very rarely reported. This case is first report of sternocostal involvement in CRMO associated with UC.     

Endoscopic evaluation of patients with inflammatory bowel disease

Endoscopy plays a critical role in the diagnosis and management of inflammatory bowel disease (IBD). This article reviews the utility of endoscopy in the diagnosis of ulcerative colitis (UC) and Crohn's disease (CD), recommendations for cancer surveillance, and the use of newer techniques for the enhanced detection of dysplasia in chronic UC. Finally, the use of endoscopy for the management of certain complications of IBD is also discussed.     

Indeterminate colitis

A diagnosis of Crohn's disease (CD) and ulcerative colitis (UC) is based on a combination of clinical, histologic, endoscopic, and radiologic data. The distinction between UC and CD can be difficult because of the lack of a differentiating single gold standard. Indeterminate colitis (IC) was introduced by pathologists for the diagnosis of surgical colectomy specimens showing an overlap between the features of UC and CD. The diagnosis of IC was based on macroscopic and microscopic features. The term indeterminate colitis is in recent years more widely applied to include all cases with endoscopic, radiographic, and histologic evidence of chronic inflammatory bowel disease confined to the colon, but without fulfilment of diagnostic criteria for UC and CD. As for UC and CD, the diagnosis of IC has therefore become a clinicopathologic diagnosis. IC is generally considered to be a temporary diagnosis. The clinical characteristics of patients with IC are, however, somewhat different from the characteristics of those with UC. Furthermore, serologic markers such as perinuclear antineutrophil cytoplasmic antibody and anti-Saccharomyces cerevisiae, which are strongly linked with UC and CD, are both negative in a subset of patients with IC. Therefore, the possibility that IC could be a separate entity must be investigated.     

Gastral antral biopsy in the differentiation of pediatric colitides

OBJECTIVES: Differentiation of Crohn's disease (CD) from ulcerative colitis (UC) is problematic, primarily when inflammation is confined to the colon. In a historical cohort study, we evaluated the usefulness of baseline gastric antral biopsies in the differentiation of pediatric chronic colitides. METHODS: During initial investigation for suspected inflammatory bowel disease, 39 children and adolescents with colitis but normal small bowel radiography underwent pretreatment upper endoscopy concurrently with colonoscopy. Two reviewers assigned a colonoscopic diagnosis (colonic CD, UC, or indeterminate colitis) based on the macroscopic and microscopic appearances of the colonic mucosa. Antral histological findings were compared between groups using Fisher's exact test. RESULTS: Five (14%) of colonoscopic diagnoses (four indeterminate, one UC) were changed to CD by the finding of granulomatous inflammation in antral biopsies. Nonspecific antral gastritis was found in similar proportions of children and adolescents with Crohn's colitis and UC (92% vs 75%). Focal antral gastritis was more common in patients with Crohn's colitis than UC (52% vs 8%). CONCLUSIONS: Nonspecific antral gastritis is common in all forms of chronic colitis. Nevertheless, upper gastrointestinal endoscopy with biopsy is useful in the differentiation of inflammatory bowel disease confined to the colon, particularly when colonoscopic findings are indeterminate.     

Value of colonoscopy for prediction of prognosis in patients with ulcerative colitis

Ulcerative colitis （UC） is a chronic inflammatory bowel disorder characterized by exacerbations and remissions. Some UC patients remain refractory to conventional medical treatment while, in others, the effectiveness of drugs is limited by side-effects. Recently, cyclosporine and leukocyte removal therapy have been used for refractory UC patients. To predict the efficacy of these therapies is important for appropriate selection of treatment options and for preparation for colectomy. Endoscopy is the cornerstone for diagnosis and evaluation of UC. Endoscopic parameters in patients with severe or refractory UC may predict a clinical response to therapies, such as cyclosporine or leukocyte removal therapy. As for the patients with quiescent UC, relapse of UC is difficult to predict by routine colonoscopy. Even when routine colonoscopy suggests remission and a normal mucosal appearance, microscopic abnormalities may persist and relapse may occur later. To more accurately identify disease activity and to predict exacerbations in UC patients with clinically inactive disease is important for deciding whether medical treatment should be maintained. Magnifying colonoscopy is useful for the evaluation of disease activity and for predicting relapse in patients with UC.     

Similarity of colorectal cancer in Crohn's disease and ulcerative colitis: implications for carcinogenesis and prevention.

Colorectal cancer is the most frequent malignant complication in patients with inflammatory bowel disease. Eighty patients with colorectal cancer complicating Crohn's disease (CD) or ulcerative colitis (UC) with median ages at diagnosis of colorectal cancer of 54.5 years and 43.0 years respectively were studied. The median duration of disease to the diagnosis of cancer was long (CD 15 years; UC 18 years). Most cancers developed after more than eight years of disease (CD 75%; UC 90%). Patients with multiple carcinomas at diagnosis were equally common (CD 11%; UC 12%). Carcinoma occurred in the area of macroscopic disease in most patients (CD 85%; UC 100%). Mucinous and signet ring histological features were equally common (CD 29%; UC 21%). Dysplasia was present with similar frequency in both diseases (CD 73%; UC 79%). The overall five year survival rates were also similar (CD 46%; UC 50%). These findings show that carcinomas complicating CD and UC have strikingly similar clinicopathological features and suggest that a common underlying process, such as chronic inflammation, maybe important in the pathogenesis of colorectal carcinoma.     

Ulcerative Colitis in Infancy

Ulcerative colitis (UC) is a chronic idiopathic inflammatory disorder of colon. Frequency of UC is gradually increasing over few years worldwide. Prevalence is 35 to 100/100 000 people in USA, 1% of them are infants. UC develops in a genetically predisposed individual with altered intestinal immune response. An eight-month-old girl presented with loose bloody stool, growth failure, and moderate pallor. The girl was diagnosed as a case of UC by colonoscopy and biopsy. Treatment was thereafter started with immunosuppressive drugs. After initial induction therapy with parenteral steroid and infliximab, the patient is now on remission with azathioprine and mesalamine. UC is rare in Bangladesh, especially in children, and it is rarer during infancy. Several conditions like infective colitis, allergic colitis, Meckel''s diverticulitis, Crohn''s disease, etc. may mimic the features of UC. So, if a child presents with recurrent bloody diarrhea, UC should be considered as differential diagnosis.     

MAGNIFYING COLONOSCOPY FOR THE DIAGNOSIS OF INFLAMMATORY CHANGES IN ULCERATIVE COLITIS

Background: Endoscopic observation is the most effective method for the evaluation of staging in ulcerative colitis (UC). However, in cases with very mild inflammatory activity, histopathological diagnosis may also be required. Unfortunately, biopsy‐related accidents are not uncommon. As an alternative, we have used a magnifying colonoscope commonly used for tumor diagnosis to examine in detail the colon mucosa of UC patients in clinical remission, and then compared these findings relative to conventional endoscopy using histopathological diagnosis. Subjects and Methods: Among UC cases examined by colonoscopy between April 2000 and April 2005, 27 cases without hematochezia for at least 1 month were enrolled in this study. Following observations of inflammatory changes using conventional colonoscopy, magnifying observation and biopsies at a total of 144 sites were evaluated. Using histopathological standards, acute‐phase inflammation was indicated by the presence of neutrophil infiltration, whereas chronic‐phase inflammation was indicated by infiltration of lymphocytes, plasma cells and eosinophils. Results: Indicators of significant inflammation by conventional observation was erosion. Under magnification, inflammation appears as superficial defects in mucosa and small whitish spots. When the presence of infiltrating neutrophils was used as a positive histological marker for inflammation, there was no difference in the accuracy of diagnosis by conventional observation (95.1%) versus magnifying observation (97.2%). In contrast, when lymphocyte infiltration was used as a marker, the accuracy of diagnosis increased significantly (88.2%) using magnifying observation relative to conventional observation (61.1%). Conclusions: Magnifying endoscopy can be used effectively in the evaluation of minute mucosal changes in cases of UC remission.     

Incidence of inflammatory bowel disease in Corsica from 2002 to 2003

OBJECTIVES: The aim of this prospective epidemiological study was to determine the incidence of inflammatory bowel diseases (IBD) in Corsica using the same methodology as that of the EPIMAD registry. METHODS: Between January 1st, 2002 and December 31, 2003, all gastroenterologists in Corsica (N=19) enrolled patients consulting for the first time with clinical symptoms compatible with IBD. Each case was reviewed by another expert gastroenterologist to assign a diagnosis of definite, probable, possible Crohn's disease (CD), ulcerative colitis (UC) or unclassified/able chronic colitis. RESULT: Eighty-one new cases were recorded, including seventy-one diagnoses of IBD (definite and probable cases), with 20 (28%) CD, 49 (69%) UC and 2 (3%) unclassifiable chronic colitis. The age-adjusted incidence (per 105 inhabitants/year) was 4.05 for CD and 9.5 for UC. The female/male ratio and median age at time of diagnosis were 1.3 and 29 years for CD and 0.63 and 44 years for UC, respectively. The median time from symptom onset to diagnosis was five months for both diseases. CONCLUSION: In Corsica, the observed incidence of CD is close to that observed in other metropolitan French regions. These data are contrary to the north-south gradient reported for this disease. Our figure of 9.5/10(5) for UC in Corsica is two-fold higher than reported in other metropolitan French regions. Genetic and/or environmental factors may explain these findings.