Ulcerative Colitis (cont.)
Adam Schoenfeld, MD
George Y. Wu, MD, PhD
In this Article
How is the Diagnosis of Ulcerative Colitis Made?
The diagnosis of ulcerative colitis is suggested by the symptoms of abdominal pain, rectal bleeding, and diarrhea. As there is no gold standard for diagnosis, the ultimate diagnosis relies on a combination of symptoms, the appearance of the colonic lining at the time of endoscopy, histologic features of biopsies of the colonic lining, and studies of stool to exclude the presence of infectious agents that may be causing the inflammation.
Knowledge of the extent and severity of the colitis is important in choosing among treatment options.
Some newer diagnostic modalities include video capsule endoscopy and CT/MRI enterography. Video capsule endoscopy (VCE) might be useful for detection of small bowel disease in patients with a diagnosis of UC with atypical features and who might be suspected of actually having Crohn's disease. With VCE, patients swallow a capsule that contains a camera that takes pictures while it travels through the intestines and sends the pictures wirelessly to a recorder. The pictures are then reviewed. In a study in 2007, VCE confirmed the presence of small bowel disease in about 15% of patients with ulcerative colitis with atypical features or unclassified inflammatory bowel disease, thus changing the diagnosis to Crohn's disease. This might be a useful diagnostic modality in this specific patient population.
CT and MRI enterography are imaging techniques which use oral liquid contrast agents consisting of PEG solutions or low concentration of barium to provide more adequate distension of the colon and small intestine. These have been reported to be superior to standard imaging techniques in the evaluation of small bowel pathology in patients with Crohn's disease. They have also been shown to provide adequate estimations of disease severity in ulcerative colitis (with some under- and overestimations).
Medically Reviewed by a Doctor on 7/16/2014
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