Diagnosis of ulcerative colitis
Frist, the doctor will hear your complaint and ask you about your symptoms, such as bloody diarrhea, rectal bleeding, and abdominal pain. He will ask you about general health and your medical history. He also will ask you about your family history.
After history taking, your doctor will perform a physical examination to see findings, such as abdominal pain and tenderness, abdominal distension and swelling, paleness of anemia, and other extraintestinal manifestations. He also will listen to the intestinal sounds by stethoscope.
After history taking and physical examination, your doctor will suspect more than a disease can cause these symptoms. Thus, he will request further investigations to rule out other conditions, confirm his diagnosis, and determine the extent and severity of the disease.
These investigations include:
- Blood examination: Complete blood count (CBC) may show low red blood cell count, which indicates anemia. Also, blood examination may show inflammatory markers and specific antibodies, such as pANCA (perinuclear antineutrophil cytoplasmic antibodies), that appear in 70% of the cases.
- Stool examination: Stool samples may reveal white blood cells and lactoferrin, which indicates intestinal inflammation. It also rules out infections, such as bacterial, viral, or parasitic infections. The fecal calprotectin test is sensitive to ulcerative colitis. This test becomes elevated early in the disease even before inflammatory markers, which helps in the prevention of disease progression.
Blood and stool examination are helpful, but confirmation of ulcerative colitis requires visualization of the large intestine to see the lesion. The most accurate techniques that enable the doctor to visualize the large intestine are endoscopies that include:
The Flexible sigmoidoscopy is a thin, flexible tube that contains a camera to visualize the rectum and sigmoid colon. The doctor will insert this endoscope through the anus, and the camera will send a video image for the lining of the rectum and sigmoid colon. The doctor may need to take a biopsy by the endoscope to send it to a pathologist for examination. If the diagnosis is unclear or the doctor thinks that ulcerative colitis affects more than the rectum and sigmoid colon, he may do a full colonoscopy.
The Colonoscopy is a thin, flexible tube attached to a camera like the flexible sigmoidoscopy, but it allows the doctor to examine the entire colon during the procedure. Like flexible sigmoidoscopy, the doctor can take biopsies from the colon to send it for pathological examination.
In ulcerative colitis, the previous endoscopic techniques will show:
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- Erythema (redness) and friability of the colonic mucosa
- Ulcers in the colon
- Loss of the natural appearance of the colon
- Abnormal growths called polyps (in 15% of the cases)
- The lesion in ulcerative colitis always involves the rectum and extends to the colon in a continuous pattern.
Endoscopy determines the type of disease according to the extent of the lesion.
If the diagnosis is still unclear, the doctor will request a biopsy from the affected area of the bowel at the time of endoscopy. Histological examination of a biopsy can make a definitive diagnosis and exclude Crohn’s disease.
In ulcerative colitis, the biopsy will show the following:
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- The lesion is limited to the mucosal and submucosal layers of the bowel wall. Unlike ulcerative colitis, Crohn’s disease affects the entire bowel wall (mucosa, submucosa, and muscle layer)
- Crypt abscesses
- Hemorrhage and inflammatory cells
Also, biopsies are useful in screening for cancer colon, which is the most dangerous complication of ulcerative colitis.
Other imaging techniques, such as X-ray and CT scan, are less useful in the diagnosis of ulcerative colitis. But, the doctor may need them to see if there are dangerous complications, such as toxic megacolon or perforated colon.
After the diagnosis of ulcerative colitis, the doctor can put his management plan, according to what he found. The management plan will depend on the severity and the extent of the disease, how often the condition flares up, and the presence of complications.
» Now, let’s discuss the treatment options of ulcerative colitis.
