Diagnosis of ulcerative colitis

A gold standard method for diagnosis of Ulcerative colitis is not currently available (1).

Diagnosis of ulcerative colitis is achieved through a combination of medical history, clinical evaluation and supported by the typical endoscopic and histological findings (1):

• proctosigmoidoscopy or colonoscopy with characteristic changes of ulcerative colitis (loss of the typical vascular pattern, granularity, friability, and ulceration)
• biopsy - to distinguish UC from infectious colitis
• negative stool examination - for infectious causes (2)

Initial laboratory investigation methods for patients with active disease at presentation include:

• full blood count - may reveal thrombocytosis, anaemia, leucocytosis
• inflammatory markers (CRP or ESR)
• electrolytes
• liver function tests
• a stool sample for microbiological testing (1)

A number of autoantibodies especially perinuclear antineutrophil cytoplasmic antibodies (pANCA) have been identified in patients with UC. (approximately 50-60% of patients are found to be positive for pANCA). Due to the low sensitivity of pANCA for the diagnosis of UC it cannot be used as a diagnostic tool (1)

Reference:

• 1. Stange EF et al. European evidence-based Consensus on the diagnosis and management of ulcerative colitis: Definitions and diagnosis. Journal of Crohn's and Colitis (2008) 2, 1-23
• 2. Kornbluth A et al. Ulcerative colitis practice guidelines in adults: American College Of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol. 2010;105(3):501-23