Ulcerative colitis
Description
- Continuous mucosal inflammation from the rectum extending proximally; colon only
- Rectum is involved in essentially all untreated cases - rectal sparing suggests Crohn or topical therapy already given
- Mucosa + submucosa only. Transmural inflammation only in fulminant disease/toxic megacolon
Extent (Montreal)
| E1 Proctitis | Rectum only (~30%) |
| E2 Left-sided | Up to splenic flexure (~40%) |
| E3 Extensive/pancolitis | Beyond splenic flexure (~30%) |
- Extent determines route of therapy (topical vs oral) and cancer surveillance
- Backwash ileitis in pancolitis - still UC
Histology
- Crypt architectural distortion, crypt abscesses, goblet cell depletion, basal plasmacytosis
- No granulomas
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