DIFFERENTIAL DIAGNOSIS OF IMMUNOINFLAMMATORY LESIONS OF THE COLON IN ULCERATIVE COLITIS AND CROHN'S DISEASE IN THE EARLY PERIOD OF THE DISEASE COURSE: CLINICAL, ENDOSCOPIC AND HISTOLOGICAL FEATURES
Abstract
Introduction. Ulcerative colitis and Crohn’s disease belong to the category of inflammatory bowel diseases (IBD). Ulcerative colitis affecting only the colon and only at the level
of the mucosa, while in Crohn’s disease, in the vast majority of cases, the immunoinflammatory process involves the terminal ileum, colon, or both of them together, with the lesion extending
to the entire thickness of the intestinal wall. Since colonic lesions occur in both variants of IBD, differential diagnosis between ulcerative colitis and Crohn's disease in isolated lesions of the
colon may represent a significant practical problem, especially in the absence of unambiguous endoscopic and histologic signs of Crohn's disease. Aim of the study: to develop a method of differential diagnostics of ulcerative colitis and Crohn’s disease in isolated lesions of the colon in the early period of the course of IBD on the basis of clinical, endoscopic and histologic features
of the disease. Materials and Methods. Medical records of 95 patients from the 2021–2023 in the early period of the IBD course were included in the cross-sectional study conducted on the
basis of the IBD City Center of St. Petersburg city clinic “Elizavetinskaya Hospital”: the period from the moment of initial diagnosis to the moment of total ileocolonoscopy with multifocal
biopsy and histological examination of biopsy specimens studied in the framework of the study was not more than 12 months. In the studied observational sample, 35 patients had ulcerative
colitis and 60 patients had Crohn’s disease as colitis and ileocolitis. The median age of patients with was 30 years (Q1=24; Q3=41) for ulcerative colitis and 35 years (Q1=26; Q3=50) for Crohn’s
disease. Results. The logistic regression model was created that allows differential diagnosis of Crohn's disease with colonic lesions and ulcerative colitis on the basis of clinical, endoscopic
and histologic predictors with sensitivity 92%, specificity 69% and accuracy 83% (AUC 0.885). Predictors of Crohn's disease in the model were endoscopically detected segmental intestinal
lesions, the presence of blood in the stool and abdominal pain syndrome, while predictors of ulcerative colitis were a decrease in the number of goblet cells, the presence of crypt deformation,
crypt abscesses, the presence of mucus in the stool, and a change in the consistency of the stools toward unformed, mushy or liquid. Conclusion. This fitted model can be used for
differential diagnosis between ulcerative colitis and Crohn's disease in difficult diagnostic situations in IBD, when the most probable pathognomonic signs of Crohn's disease are absent, such
as pathologic changes in the mucosa of the terminal ileum, the presence of strictures, fistulas and perianal manifestations, histologic discontinuity of intestinal lesions and the presence of
granulomas.
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