. 2025 Jul 2;60(9):1118–1144. doi: 10.1007/s00535-025-02271-7

Table 4.

Diagnostic characteristics of untreated pediatric ulcerative colitis

	Characteristics
Class 1: Never found with UC	1. At least one granuloma in any part of the gastrointestinal tract that is distal to the ruptured crypt 2. One deep ulcer, cobblestone appearance, or stricture anywhere in the small intestine or upper digestive tract (but not in the stomach) 3. Fistula in the gastrointestinal tract or perianal region 4. Presence of a large perianal inflammatory dermoid 5. Imaging studies indicating thickening of the jejunum or ileum or capsule endoscopy indicating significant small bowel inflammation that is not backwash ileitis 6. Significant inflammation of the ileum not caused by backwash ileitis
Class 2: Rarely found (< 5%) with UC	7. Endoscopically and histologically normal skip lesions, but not rectal sparing or cecal patch 8. Endoscopically and histologically complete rectal sparing (normal rectal sparing comprises a histologic lesion in the rectum) 9. Histologic evidence of inflammation in the colonic mucosa despite endoscopic biopsy of a normal portion of the colon with evidence of surrounding inflammation 10. Severe growth restriction (growth rate standard deviation < − 2) that cannot be explained by other causes (e.g., long-term steroid use, growth hormone secretion failure) 11. Presence of generalized inflammation of the colon in the absence of severe colitis 12. Presence of small, shallow ulcers (including aphthous ulcers) in the small intestine, duodenum, or esophagus (excluding the stomach and colon) that cannot be explained by other causes (Helicobacter pylori infection, NSAIDs) 13. Multiple (> 5) small, shallow ulcers (including aphthous ulcers) in the stomach or colon with normal background mucosa that cannot be explained by other causes (H. pylori infection, NSAIDs) 14. Backwash ileitis despite markedly mild inflammation in the cecum 15. Anti-Saccharomyces cerevisiae antibody-positive and perinuclear anti-neutrophil cytoplasmic antibody-negative findings 16. Inflammation of the colonic mucosa is more intense on the oral side than on the anorectal side (except for rectal sparing) 17. Severe scalloping of the stomach or duodenum that cannot be explained by other causes (e.g., H. pylori infection) 18. At least one deep ulcer or severe cobblestone appearance in the stomach that cannot be explained by other causes (H. pylori infection, NSAIDs)
Class 3: Occasionally found with UC (5–10%)	19. Histopathology reveals focal chronic duodenitis 20. Histopathology reveals localized active colitis in multiple specimens 21. Multiple (< 5) aphthous ulcers in the colon or stomach 22. Nonbloody diarrhea 23. Histopathology of the stomach indicates focal enhanced gastritis (gastritis forming a focal inflammatory cell infiltrate)

Characteristics

Class 1: Never found with UC

1. At least one granuloma in any part of the gastrointestinal tract that is distal to the ruptured crypt

2. One deep ulcer, cobblestone appearance, or stricture anywhere in the small intestine or upper digestive tract (but not in the stomach)

3. Fistula in the gastrointestinal tract or perianal region

4. Presence of a large perianal inflammatory dermoid

5. Imaging studies indicating thickening of the jejunum or ileum or capsule endoscopy indicating significant small bowel inflammation that is not backwash ileitis

6. Significant inflammation of the ileum not caused by backwash ileitis

Class 2: Rarely found (< 5%) with UC

7. Endoscopically and histologically normal skip lesions, but not rectal sparing or cecal patch

8. Endoscopically and histologically complete rectal sparing (normal rectal sparing comprises a histologic lesion in the rectum)

9. Histologic evidence of inflammation in the colonic mucosa despite endoscopic biopsy of a normal portion of the colon with evidence of surrounding inflammation

10. Severe growth restriction (growth rate standard deviation < − 2) that cannot be explained by other causes (e.g., long-term steroid use, growth hormone secretion failure)

11. Presence of generalized inflammation of the colon in the absence of severe colitis

12. Presence of small, shallow ulcers (including aphthous ulcers) in the small intestine, duodenum, or esophagus (excluding the stomach and colon) that cannot be explained by other causes (Helicobacter pylori infection, NSAIDs)

13. Multiple (> 5) small, shallow ulcers (including aphthous ulcers) in the stomach or colon with normal background mucosa that cannot be explained by other causes (H. pylori infection, NSAIDs)

14. Backwash ileitis despite markedly mild inflammation in the cecum

15. Anti-Saccharomyces cerevisiae antibody-positive and perinuclear anti-neutrophil cytoplasmic antibody-negative findings

16. Inflammation of the colonic mucosa is more intense on the oral side than on the anorectal side (except for rectal sparing)

17. Severe scalloping of the stomach or duodenum that cannot be explained by other causes (e.g., H. pylori infection)

18. At least one deep ulcer or severe cobblestone appearance in the stomach that cannot be explained by other causes (H. pylori infection, NSAIDs)

Class 3: Occasionally found with UC (5–10%)

19. Histopathology reveals focal chronic duodenitis

20. Histopathology reveals localized active colitis in multiple specimens

21. Multiple (< 5) aphthous ulcers in the colon or stomach

22. Nonbloody diarrhea

23. Histopathology of the stomach indicates focal enhanced gastritis (gastritis forming a focal inflammatory cell infiltrate)

Adapted from [13], with partial modification

NSAIDs nonsteroidal anti-inflammatory drugs, UC ulcerative colitis