Ulcerative colitis in protracted remission

Colonoscopic biopsies from 32 patients were studied at the ultrastructural level using a scanning electron microscope (SEM). Sixteen of the 32 patients had a previous diagnosis of total ulcerative colitis (UCR> 10 years) in protracted remission. The colonic mucosa was normal at endoscopic and histologic examinations (UCRN). The remaining 16 patients had normal colonic mucosa, but had an adenoma or an adenocarcinoma elsewhere in the colon. Several ultrastructural parameters were investigated, such as the number of crypts per area, the distance between the crypts, the outline of mucosal units, the number of mucous cells, the outline of absorptive cells, and the number of villi per area. Quantitative determinations of SEM structures (including measurements with an interactive digital image analyzer system; MOP 30, Zeiss Contron) were made. The results showed no significant differences between the various parameters (except for the number of crypts per area) between patients with UCRN and controls. The possibility of a total (or quasi-total)restitutio ad integrum of the colonic mucosa in certain patients with UCR is discussed. An international policy regarding the colonoscopic surveillance of patients with UCRN should be elaborated. It is suggested that the time interval between control colonoscopic biopsies in patients with UCRN should be increased substantially. Supported by grants from the Karolinska Institute and the Cancer Society of Stockholm.