From the Guidelines
Diagnostic Workup for Colitis
The diagnostic workup for colitis should start with a thorough medical history and physical examination. Initial laboratory tests should include a complete blood count, electrolyte panel, liver function tests, and stool studies to rule out infectious causes 1.
Endoscopic Evaluation
Endoscopic evaluation with colonoscopy is essential for direct visualization of the colon and to obtain biopsy samples for histopathological examination 1. In cases of acute severe colitis, flexible sigmoidoscopy with mucosal biopsy is an appropriate initial investigation, which can help differentiate ulcerative colitis from other causes of acute colitis 1.
Imaging Studies
Imaging studies such as abdominal X-rays or computed tomography (CT) scans may be ordered to assess the extent of disease and potential complications 1. A plain abdominal radiograph should be performed to exclude colonic dilatation and to estimate the extent of disease.
Key Points
- Initial laboratory tests should include a complete blood count, electrolyte panel, liver function tests, and stool studies to rule out infectious causes.
- Endoscopic evaluation with colonoscopy is essential for direct visualization of the colon and to obtain biopsy samples for histopathological examination.
- Imaging studies such as abdominal X-rays or CT scans may be ordered to assess the extent of disease and potential complications.
- Flexible sigmoidoscopy with mucosal biopsy is an appropriate initial investigation in cases of acute severe colitis.
Additional Considerations
In established cases of IBD, endoscopy during an acute flare is an important tool in determining the severity of the disease flare 1. The presence of extensive and deep ulcerations at endoscopy is associated with an increased risk of colectomy for UC in that admission. Endoscopy can also be useful in predicting response to rescue therapy using cyclosporine or infliximab.
From the Research
Diagnostic Workup for Colitis
The diagnostic workup for colitis involves a combination of clinical evaluation, endoscopic assessment, and histological examination.
- The clinical evaluation includes assessing the patient's symptoms, medical history, and physical examination findings 2, 3, 4.
- Endoscopic assessment, such as colonoscopy or proctosigmoidoscopy, is essential for visualizing the colon and obtaining biopsy samples 2, 3, 5.
- Histological examination of biopsy samples is crucial for establishing a definitive diagnosis of colitis and differentiating between various types of colitis 2, 4, 6.
Biopsy Diagnosis
- A systematic approach to biopsy diagnosis is recommended, utilizing a pattern-based algorithmic approach to evaluate biopsies and recognize patterns of injury 6.
- Biopsy samples should be evaluated for distinct histologic features, such as those seen in collagenous colitis, lymphocytic colitis, and ischemic colitis 4, 6.
- The presence of lymphoplasmacytic inflammation, neutrophilic inflammation, eosinophilic inflammation, or paucicellular colitis can help narrow the differential diagnosis and guide clinical management 6.
Endoscopic Features and Clinical Data
- Endoscopic features, such as the presence of ulcers, erosions, or inflammation, can provide valuable information for diagnosing colitis 2, 3.
- Clinical data, including the patient's symptoms, medical history, and laboratory findings, are essential for interpreting biopsy results and establishing a definitive diagnosis 2, 4.
- The combination of endoscopic features, clinical data, and histological examination can help establish a definitive diagnosis of colitis and guide treatment decisions 2, 3, 4, 5, 6.