Differentiation Of Ulcerative Colitis Research Articles

Differentiation of Active Ulcerative Colitis vs Noninflammatory Bowel Disease Proctitis by Transperineal Superb Microvascular Imaging.

Transabdominal ultrasonography and transperineal ultrasonography (TPUS) appear correspond to colonoscopy (CS) for evaluating ulcerative colitis (UC) activity, but their utility in UC diagnosis remains unclear. This research compared the accuracy of TPUS and CS for assessing rectal activity and differentiating noninflammatory bowel disease proctitis from UC in pediatric cases. The study is a blinded, prospective, and controlled trial. Prospectively, values of fecal calprotectin (FCP) and findings of the TPUS and CS were compared between child cases of UC and non-IBD proctitis. Findings of rectal wall thickening (RWT), rectal wall flow (RWF) on power Doppler, and microvascular signal at wall circumference (MSWC) on monochrome superb microvascular imaging assessed using TPUS were compared with the CS. Thirty patients with Mayo endoscopic subscore (MES) 0 to 1 UC, 57 with MES 2 to 3 UC, and 44 with proctitis were registered. Fecal calprotectin, RWF, and MSWC indicated significant differences among the groups (P < .05). Rectal wall thickening showed no significant difference between MES 0-1 and proctitis (P = .76). Rectal wall thickening and MSWC were independent predictors of endoscopic activity of UC, resulting in a sensitivity and specificity of 100% for RWT ≥4.5 mm and positive MSWC. Fecal calprotectin and RWF were independent predictors for differentiating MES 0 to 1 and proctitis, and FCP and RWT were independent predictors for differentiating MES 2 to 3 and proctitis. Sensitivity and specificity were 77.2% and 80.9%, respectively, for FCP >242.5 μg/g and RWF negative; and they were both 100% for RWT >4.1 mm and MSWC positive. Transperineal ultrasonography with mSMI may enable the evaluation of rectal activity and differentiation of UC from non-IBD proctitis with accuracy comparable to endoscopy.

Pediatric inflammatory bowel disease: continuous lessons for adult inflammatory bowel disease.

Prospective and inception inflammatory bowel disease (IBD) cohorts offer excellent opportunities to develop risk stratification strategies, use relevant tissue to explore the biology of IBD progression, and study the natural history of IBD in the era of biological therapy. Adult IBD care can learn important lessons from recent pediatric IBD studies. A recent multicenter inception cohort of pediatric IBD patients examining genetic, serologic, and microbiome data at diagnosis has been able to create a model for prediction of disease complications, describe compositional changes in gut microbiota associated with disease severity, identify markers of intestinal fibrosis, and confirm how important early life environmental exposures affect disease severity and phenotype. Analysis of gene and protein expression in mucosal samples has been shown to offer both diagnostic information about differentiation of ulcerative colitis (UC) vs. crohn's disease as well as implications for treatment efficacy. Important developments in treatment of growth failure with antitumor necrosis factor therapy, the effect of oral medication noncompliance, and dietary IBD therapy are outlined. Pediatric IBD research has been focusing on better phenotyping at diagnosis, and development of molecular signatures of future disease behavior by using relevant intestinal tissue rather than blood. This has moved IBD from being a heterogeneous group of diseases with an unknown disease course to a better-defined condition in which patients are accurately risk stratified and treated based on individualized distinct biological and clinical information.

The combination of fecal calprotectin with ESR, CRP and albumin discriminates more accurately children with Crohn’s disease

PurposeIncreased fecal calprotectin is a sensitive marker of various types of intestinal inflammation. We investigated correlations between high fecal calprotectin concentration and serum inflammatory markers in children with different intestinal diseases with diarrhea with/without blood and/or abdominal pain, to test whether the combination of these markers can differentiate potential patients with inflammatory bowel disease. Materials/methodsThe study included 128 children with high fecal calprotectin concentration (>150ug/g) and symptoms suggesting bowel disorders, hospitalized in the years 2013– 2015. Twenty-six (20%) patients were diagnosed with Crohn’s disease, 55 (43%) with ulcerative colitis, 32 (25%) with intestinal infection and 15 (12%) with food protein induced proctocolitis. ResultsSignificantly increased inflammatory markers were detected in children with inflammatory bowel disease, with a correlation between calprotectin and erythrocyte sedimentation rate – ESR (R = 0.53), mean corpuscular volume – MCV (R=-0.64), red blood cell distribution width (R = 0.56), albumin (R = −0.52), hemoglobin (R = −0.53) only in Crohn’s disease patients. To discriminate Crohn’s disease patients from patients with intestinal infection and patients with food protein induced proctocolitis, AUC analysis was performed. It revealed that considering ESR, CRP and albumin as additional markers to fecal calprotectin significantly improved diagnostic performance (AUC 0.917, p = 0.038). ConclusionsIn children with abdominal pain and/or diarrhea, increased ESR, CRP and decreased albumin combined with a high fecal calprotectin level yields additional diagnostic value in screening potential patients with Crohn’s disease. As far as differentiation of ulcerative colitis is concerned, low additional diagnostic value was found when high fecal calprotectin was combined with albumin.

Role of endoscopy in inflammatory bowel disease.

Crohn’s disease (CD) and ulcerative colitis (UC) constitute the two most common phenotypes of inflammatory bowel disease (IBD). Ileocolonoscopy with biopsy has been considered the gold standard for the diagnosis of IBD. Differential diagnosis of CD and UC is important, as their medical and surgical treatment modalities and prognoses can be different. However, approximately 15% of patients with IBD are misdiagnosed as IBD unclassified due to the lack of diagnostic certainty of CD or UC. Recently, there has been increased recognition of the role of the therapeutic endoscopist in the field of IBD. Newer imaging techniques have been developed to aid in the differentiation of UC vs CD. Furthermore, endoscopic balloon dilation and stenting have become an integral part of the therapeutic armamentarium of CD stricture management. Endoscopic ultrasound has been recognized as being more accurate than magnetic resonance imaging in detecting perianal fistulae in patients with CD. Additionally, chromoendoscopy may help to detect dysplasia earlier compared with white-light colonoscopy. Hence, interventional endoscopy has become a cornerstone in the diagnosis, treatment and management of IBD complications. The role of endoscopy in the field of IBD has significantly evolved in recent years from small-bowel imaging to endoscopic balloon dilation and use of chormoendoscopy in dysplasia surveillance. In this review article, we discuss the current evidence on interventional endoscopy in the diagnosis, treatment and management of IBD compications.

Tu1520 Development and Initial Validation of a Unique Score for In Vivo Differentiation of Ulcerative Colitis and Crohn's Disease Featuring Confocal LASER Endomicroscopy

Tu1520 Development and Initial Validation of a Unique Score for In Vivo Differentiation of Ulcerative Colitis and Crohn's Disease Featuring Confocal LASER Endomicroscopy

Mo1638 Confocal LASER Endomicroscopy for In Vivo Differentiation Between Ulcerative Colitis and Crohn's Disease

Differentiation of ulcerative colitis (UC) and Crohn's disease (CD) is of paramount importance as both disease entities involve different therapeutic management strategies. Confocal laser endomicroscopy (CLE) allows on demand in vivo differentiation of architectural and cellular details during endoscopy.

PR3-ANCA: A promising biomarker for the differentiation of ulcerative colitis and Crohn's disease

PR3-ANCA: A promising biomarker for the differentiation of ulcerative colitis and Crohn's disease

A new approach using tissue alkaline phosphatase histochemistry to identify Crohn's disease

In the present study, we investigate intestinal alkaline phosphatase activity in mucosal biopsies in patients with inflammatory bowel disease. Crohn's disease influences the alkaline phosphatase activity in the intestine, increasing its activity. We present a histochemistry-based method for alkaline phosphatase that is useful for the identification of Crohn's disease and the differentiation of ulcerative colitis.

Radiographic imaging of inflammatory bowel disease

Radiographic imaging studies have an important role in the workup of patients with suspected IBD and in the differentiation of ulcerative colitis and Crohn's disease. Because of its ability to depict fine mucosal detail, the double-contrast barium study is a valuable technique for diagnosing ulcerative colitis and Crohn's disease even in patients with early disease. In contrast, cross-sectional imaging studies such as CT, MR, and ultrasound are useful for showing the effects of these conditions on the wall of the bowel and also for demonstrating intra-abdominal abscesses and other extraluminal findings in patients with more advanced disease. Thus, barium studies and cross-sectional imaging studies have complementary roles in the evaluation of these patients.

Poor diagnostic value of colonic CD44v6 expression and serum concentrations of its soluble form in the differentiation of ulcerative colitis from Crohn’s disease

Background—Increased expression of CD44v6 on colonic crypt epithelial cells in ulcerative colitis has been suggested as a diagnostic tool to distinguish ulcerative colitis from colonic Crohn’s disease.Aims—To investigate colonic CD44v6...

Diffuse mucosal granularity in double-contrast studies of Crohn's disease of the colon

The radiographic manifestations of idiopathic ulcerative colitis and Crohn's disease of the colon have been extensively reviewed and are well known. The increasing use of primary double-contrast barium enemas in patients with inflammatory bowel disease has led to enthusiastic reports concerning the differentiation of ulcerative colitis and Crohn's disease. Typically, in ulcerative colitis there is a continuous, diffuse granular mucosal pattern, with or without superadded ulceration; in contrast, Crohn's colitis is characterised by discrete ulcers with intervening normal mucosa. In this paper the occurrence of continuous diffuse mucosal granularity in Crohn's disease of the colon is described. Four selected cases are used as illustrative examples to emphasise the non-specific nature of this particular finding. Caution must be exercised in attributing specific mucosal patterns to the various forms of infectious and non-infectious colitis.

Problems in the Differentiation of Ulcerative Colitis and Crohn's Disease of the Colon: The Need for Repeated Diagnostic Evaluation

Problems in the Differentiation of Ulcerative Colitis and Crohn's Disease of the Colon: The Need for Repeated Diagnostic Evaluation

An electron microscopic study of inflammatory colonic disease.

A preliminary report on the differentiation of ulcerative colitis and granulomatous colitis by means of electron microscopy is presented.