Ament M E
J Pediatr. 1975 Mar;86(3):322-34. doi: 10.1016/s0022-3476(75)80958-9.
Ulcerative colitis differs from Crohn's colitis in several ways. In ulcerative colitis the disease is limited to the mucosa and, occasionally, the submucosa; Crohn's colitis may involve all layers of the large intestine. Ulcerative colitis almost always begins in the rectum, is diffuse, and spreads proximally. Crohn's colitis may spare the rectum and has a patchy distribution. Perianal fistulas and ulcers are rare in ulcerative colitis but are common in Crohn's colitis. Granulomas and giant cells are not found in ulcerative colitis but are seen in the majority of patients with Crohn's colitis. Colonic and extraintestinal symptoms in the two illnesses may be indistinguishable but growth failure is far more severe in Crohn's colitis and may precede intestinal symptoms by months to years. Cancer of the colon is a risk in patients with either ulcerative or Crohn's colitis but is far more common in the former. It is important to distinguish between ulcerative colitis and Crohn's colitis because response to treatment and prognosis are different. Although neither condition can be cured by medical management, patients with ulcerative colitis may respond more frequently. Unfortunately, in the pediatric age range most cases of ulcerative and Crohn's colitis may be classified as moderate to severe. Fortunately for patients with ulcerative colitis, total colectomy with ileostomy will result in cure of illness. Patients with Crohn's colitis who require surgery may obtain remission of symptoms, but the disease is likely to recur in the small intestine.
溃疡性结肠炎在几个方面与克罗恩结肠炎不同。在溃疡性结肠炎中，疾病局限于黏膜，偶尔累及黏膜下层；而克罗恩结肠炎可能累及大肠的所有层。溃疡性结肠炎几乎总是始于直肠，呈弥漫性，并向近端蔓延。克罗恩结肠炎可能不累及直肠，呈斑片状分布。肛周瘘管和溃疡在溃疡性结肠炎中很少见，但在克罗恩结肠炎中很常见。溃疡性结肠炎中不存在肉芽肿和巨细胞，但在大多数克罗恩结肠炎患者中可见。这两种疾病的结肠和肠外症状可能难以区分，但生长发育障碍在克罗恩结肠炎中更为严重，可能在肠道症状出现前数月至数年就已出现。结肠直肠癌在溃疡性结肠炎或克罗恩结肠炎患者中均有发生风险，但在前一种疾病中更为常见。区分溃疡性结肠炎和克罗恩结肠炎很重要，因为对治疗的反应和预后不同。虽然这两种疾病都不能通过药物治疗治愈，但溃疡性结肠炎患者可能更频繁地出现反应。不幸的是，在儿童年龄范围内，大多数溃疡性和克罗恩结肠炎病例可能被归类为中度至重度。对溃疡性结肠炎患者来说幸运的是，全结肠切除加回肠造口术将治愈疾病。需要手术的克罗恩结肠炎患者可能会缓解症状，但疾病很可能在小肠复发。
