I N V E S T I G A T I O N S Endoscopy and biopsy

I N V E S T I G A T I O N S Endoscopy and biopsy

Rigid/flexible sigmoidoscopy can detect proctitis in the clinic; - the mucosa is hyperaemic, bleeds on touch and there may be a -

Figure 75.4 Resection specimen from a patient with longstanding ulcerative colitis showing a narrow tubular colon with areas of cancer

ous change in the rectum and sigmoid (arrows) (courtesy of the late Professor Brian Warren, John Radcliffe Hospital, Oxford, UK).

purulent exudate. Where there has been remission and relapse, there may be regenerative mucosal nodules or pseudopolyps. Later, tiny ulcers may be seen that appear to coalesce. Colonos copy with biopsy has a key role in diagnosis and management: /uni25CF to establish the extent of inflammation, although colonos copy is contraindicated in severe acute colitis because of the risk of colonic perforation; /uni25CF to distinguish between UC and Crohn’s colitis ( Table 75.1 /uni25CF to monitor the response to treatment; /uni25CF to assess longstanding cases for malignant change. Endoscopic findings can be combined with clinical features and the physician’s assessment to produce a disease activity score. The most widely used is the Mayo score, which provides a useful tool for measuring disease prog ression or response to treatment ( Table 75.2 ).

Crohn’s disease (CD). UC CD Macroscopic Distribution Colon/rectum Anywhere in the gastrointestinal tract Rectum Always involved Often spared Perianal disease Rare Common Fistula formation Rare Common Stricture Rare Common Microscopic Layers involved Mucosa/submucosa Full thickness Granulomas No Common Fissuring No Common Crypt abscesses Common Rare