Choi Chang Hwan, Jung Sung Ae, Lee Bo In, Lee Kang Moon, Kim Joo Sung, Han Dong Soo
Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.
Korean J Gastroenterol. 2009 Mar;53(3):145-60.
Ulcerative colitis is a chronic inflammatory disorder causing mucosal inflammation of the colorectum with crypt abnormality on biopsy. It affects the rectum and a variable extent of the colon in continuity. Ulcerative colitis is characterized by a relapsing and remitting course. It arises from an interaction between genetic and environmental factors, but the precise etiology is unknown. The incidence and prevalence in Korea are still low compared with those of Western countries, but have increased in recent years. There are many challenging issues on the diagnosis of ulcerative colitis, and sometimes these lead to differences in practice between clinicians. Therefore, IBD Study Group of KASID set out the Korean diagnostic guideline of ulcerative colitis. The diagnosis is based on clinical, endoscopic, radiologic, and histologic criteria. The symptoms are dependent upon the extent and severity of disease and most commonly include bloody diarrhea, rectal bleeding, and/or urgency. The systemic symptoms of malaise, tachycardia, fever, or weight loss are features of a severe attack. The laboratory findings may reveal leucocytosis, thrombocytosis, iron deficiency anemia, hypoalbuminemia, and elevated erythrocyte sedimentation rate and C-reactive protein indicating severe disease activity or chronicity. For the elimination of infectious causes, microbial investigation with stool specimens should be performed for common enteric pathogens including assays for Clostridium difficile toxin, and sometimes for amoeba or other parasites. The most typical endoscopic features are continuous, confluent, and concentric colonic involvement proximal to the anal verge. Endoscopic severity may be best well reflected by the presence of mucosal friability, spontaneous bleeding, and deep ulcerations. Typical pathologic findings are composed of widespread crypt architectural distortion (cryptitis, crypt abscess, and crypt atrophy), heavy, diffuse lamina propria cell infiltration, and basal plasmacytosis.
溃疡性结肠炎是一种慢性炎症性疾病，可导致结直肠黏膜炎症，活检显示隐窝异常。它会连续性地累及直肠和不同程度的结肠。溃疡性结肠炎的特点是病情呈复发和缓解过程。其发病源于遗传因素与环境因素的相互作用，但确切病因尚不清楚。与西方国家相比，韩国溃疡性结肠炎的发病率和患病率仍然较低，但近年来有所上升。溃疡性结肠炎的诊断存在许多具有挑战性的问题，有时这些问题会导致临床医生在实际操作上存在差异。因此，韩国消化疾病学会炎症性肠病研究组制定了韩国溃疡性结肠炎诊断指南。诊断基于临床、内镜、放射学和组织学标准。症状取决于疾病的范围和严重程度，最常见的症状包括便血、直肠出血和/或便急。全身症状如不适、心动过速、发热或体重减轻是严重发作的特征。实验室检查结果可能显示白细胞增多、血小板增多、缺铁性贫血、低白蛋白血症，以及红细胞沉降率和C反应蛋白升高，提示疾病活动严重或呈慢性。为排除感染性病因，应对粪便标本进行微生物检查，以检测包括艰难梭菌毒素检测在内的常见肠道病原体，有时还需检测阿米巴或其他寄生虫。最典型的内镜特征是肛门缘近端结肠呈连续性、融合性和同心性受累。内镜下的严重程度可能最好通过黏膜脆性、自发性出血和深部溃疡的存在来体现。典型的病理表现包括广泛的隐窝结构扭曲（隐窝炎、隐窝脓肿和隐窝萎缩）、大量弥漫性固有层细胞浸润和基底浆细胞增多。
