The Correlation Study Among Total Colonoscopic Findings, Clinical Symptoms and Laboratory Markers in Ulcerative Colitis

Abstract

Background and Aim: Total colonoscopy plays a crucial role in the diagnosis of ulcerative colitis (UC) by defining the pattern, extent and activity of inflammation, as well as by providing a way to obtain mucosal tissue for histological evaluation. In this study, we divided colon into seven segments(periappendicial lesion, cecum, ascending colon, transverse colon, descending colon, sigmoid colon and rectum) for endoscopic and histological findings, and assessed the relationship among these findings, clinical symptoms and laboratory data. Method: We performed total colonoscopy examinations consecutively in 56 patients with UC. To score each patient for degree of disease activity, the large intestine was divided into seven segments. Each segment was scored endoscopically, and biopsy specimens from each segment were scored for histological activity. These seven scores were summed up respectively. The patients were also evaluated using a symptom-activity index and laboratory markers, WBC count, platelet count, CRP and ESR prior to colonoscopic examination. Results: There was a significant positive correlation between symptomatic-activity scores, endoscopic (r = 0.452), and histological (r = 0.563) scores. Histological scores correlated more closely with symptomatic-activity scores than did endoscopic scores. Although the endoscopic and histological scores of the rectosigmoid colon (rectum:r = 0.608, r = 0.547. sigmoid colon:r = 0.401, r = 0.557) and descending colon(r = 0.369, r = 0.403) correlated well with clinical symptoms, there was no similar correlation for the proximal colon. WBC count, CRP and ESR were also significantly correlated with sum of endoscopic and histological scores (WBC:r = 0.338, r = 0.330. CRP:r = 0.447, r = 0.369 ESR:r = 0.483, r = 0.589), platelet count was not. Especially, CRP and ESR were well correlated with proximal (periappendicial∼descending) colon lesion (CRP:r = 0.474, r = 0.480. ESR:r = 0.423, r = 0.529). Conclusions: Clinical symptoms were reflected distal-colon lesions, on the other hand, CRP and ESR were reflected proximal-lesions. It was indicated when clinical symptoms were improved and CRP and ESR were not improved, proximal-lesions might be remained. Because especially laboratory markers were relatively less association with colon lesions, total colonoscopy should be done when clinical symptoms improve, in order to evaluate the proximal colon.