Skip to main content
NCBI home page
Gut logoLink to Gut
. 1991 Feb;32(2):174–178. doi: 10.1136/gut.32.2.174

Microscopic activity in ulcerative colitis: what does it mean?

S A Riley 1, V Mani 1, M J Goodman 1, S Dutt 1, M E Herd 1
PMCID: PMC1378803  PMID: 1864537

Abstract

To determine the prognostic importance of microscopic rectal inflammation we followed up 82 patients (aged 21 to 78 years, 44 men) with chronic quiescent ulcerative colitis over 12 months. At trial entry each patient underwent a rectal biopsy and sections were graded independently by two histopathologists. A chronic inflammatory cell infiltrate of varying severity was present in all biopsy specimens, and 58% had crypt architectural irregularities. In addition, 32% had evidence of acute inflammatory activity: 28% acute inflammatory cell infiltrate, 11% crypt abscesses, and 22% mucin depletion. Agreement between the two histopathologists for the presence of each of these features was 94% (90-98%). During the 12 month follow up 27 patients (33%) relapsed after a mean interval of 18 weeks (range 3-44 weeks). Relapse rates were unrelated to duration or extent of disease or to the type of maintenance drug treatment. In patients with an acute inflammatory cell infiltrate 52% relapsed, whereas in the absence of such an infiltrate only 25% relapsed (p = 0.02). Similarly, relapse rates were higher in the presence of crypt abscesses (78% v 27%, p less than 0.005), mucin depletion (56% v p less than 0.02), and breaches in the surface epithelium (75% v 31%, p = 0.1). The presence of a chronic inflammatory cell infiltrate or crypt architectural irregularities, however, bore no relation to the frequency of colitis relapse.

Full text

PDF
174

Images in this article

175Figure 1
on p.175
176Figure 2
on p.176

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Azad Khan A. K., Howes D. T., Piris J., Truelove S. C. Optimum dose of sulphasalazine for maintenance treatment in ulcerative colitis. Gut. 1980 Mar;21(3):232–240. doi: 10.1136/gut.21.3.232. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. BARON J. H., CONNELL A. M., LENNARD-JONES J. E. VARIATION BETWEEN OBSERVERS IN DESCRIBING MUCOSAL APPEARANCES IN PROCTOCOLITIS. Br Med J. 1964 Jan 11;1(5375):89–92. doi: 10.1136/bmj.1.5375.89. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Binder V. A comparison between clinical state, macroscopic and microscopic appearances of rectal mucosa, and cytologic picture of mucosal exudate in ulcerative colitis. Scand J Gastroenterol. 1970;5(7):627–632. [PubMed] [Google Scholar]
  4. Dick A. P., Holt L. P., Dalton E. R. Persistence of mucosal abnormality in ulcerative colitis. Gut. 1966 Aug;7(4):355–360. doi: 10.1136/gut.7.4.355. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Dissanayake A. S., Truelove S. C. A controlled therapeutic trial of long-term maintenance treatment of ulcerative colitis with sulphazalazine (Salazopyrin). Gut. 1973 Dec;14(12):923–926. doi: 10.1136/gut.14.12.923. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. FLICK A. L., VOEGTLIN K. F., RUBIN C. E. Clinical experience with suction biopsy of the rectal mucosa. Gastroenterology. 1962 Jun;42:691–705. [PubMed] [Google Scholar]
  7. Fochios S. E., Korelitz B. I. The role of sigmoidoscopy and rectal biopsy in diagnosis and management of inflammatory bowel disease: personal experience. Am J Gastroenterol. 1988 Feb;83(2):114–119. [PubMed] [Google Scholar]
  8. Korelitz B. I., Sommers S. C. Responses to drug therapy in ulcerative colitis. Evaluation by rectal biopsy and histopathological changes. Am J Gastroenterol. 1975 Nov;64(5):365–370. [PubMed] [Google Scholar]
  9. MATTS S. G. The value of rectal biopsy in the diagnosis of ulcerative colitis. Q J Med. 1961 Oct;30:393–407. [PubMed] [Google Scholar]
  10. McIntyre P. B., Rodrigues C. A., Lennard-Jones J. E., Barrison I. G., Walker J. G., Baron J. H., Thornton P. C. Balsalazide in the maintenance treatment of patients with ulcerative colitis, a double-blind comparison with sulphasalazine. Aliment Pharmacol Ther. 1988 Jun;2(3):237–243. doi: 10.1111/j.1365-2036.1988.tb00693.x. [DOI] [PubMed] [Google Scholar]
  11. Morson B. C. Rectal biopsy in inflammatory bowel disease. N Engl J Med. 1972 Dec 28;287(26):1337–1339. doi: 10.1056/NEJM197212282872607. [DOI] [PubMed] [Google Scholar]
  12. Mulder C. J., Tytgat G. N., Weterman I. T., Dekker W., Blok P., Schrijver M., van der Heide H. Double-blind comparison of slow-release 5-aminosalicylate and sulfasalazine in remission maintenance in ulcerative colitis. Gastroenterology. 1988 Dec;95(6):1449–1453. doi: 10.1016/s0016-5085(88)80061-1. [DOI] [PubMed] [Google Scholar]
  13. Powell-Tuck J., Day D. W., Buckell N. A., Wadsworth J., Lennard-Jones J. E. Correlations between defined sigmoidoscopic appearances and other measures of disease activity in ulcerative colitis. Dig Dis Sci. 1982 Jun;27(6):533–537. doi: 10.1007/BF01296733. [DOI] [PubMed] [Google Scholar]
  14. Sommers S. C., Korelitz B. I. Mucosal-cell counts in ulcerative and granulomatous colitis. Am J Clin Pathol. 1975 Mar;63(3):359–365. doi: 10.1093/ajcp/63.3.359. [DOI] [PubMed] [Google Scholar]
  15. TRUELOVE S. C., RICHARDS W. C. Biopsy studies in ulcerative colitis. Br Med J. 1956 Jun 9;1(4979):1315–1318. doi: 10.1136/bmj.1.4979.1315. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Watts J. M., Thompson H., Goligher J. C. Sigmoidoscopy and cytology in the detection of microscopic disease of the rectal mucosa in ulcerative colitis. Gut. 1966 Jun;7(3):288–294. doi: 10.1136/gut.7.3.288. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Wright R., Truelove S. R. Serial rectal biopsy in ulcerative colitis during the course of a controlled therapeutic trial of various diets. Am J Dig Dis. 1966 Nov;11(11):847–857. doi: 10.1007/BF02233941. [DOI] [PubMed] [Google Scholar]
  18. van Hees P. A., van Tongeren J. H. Compliance to therapy in patients on a maintenance dose of sulfasalazine. J Clin Gastroenterol. 1982 Aug;4(4):333–336. doi: 10.1097/00004836-198208000-00008. [DOI] [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES