Development of Fibrosis in Acute and Longstanding Ulcerative Colitis

J Crohns Colitis. 2015 Nov;9(11):966-72. doi: 10.1093/ecco-jcc/jjv133. Epub 2015 Aug 5.


Background: Intestinal fibrosis is a process driven by chronic inflammation leading to increased presence of myofibroblasts and collagen deposition. Although strictures are rarely seen in ulcerative colitis [UC], longstanding disease is believed to cause fibrosis resulting in altered bowel function.

Methods: The presence of fibrosis was studied in colectomy specimens from patients with recent-onset UC refractory to medical treatment [n = 13] and longstanding UC [n = 16], and colon cancer patients without UC [n = 7] as controls. Severity of inflammation was scored according to the Geboes score on haematoxylin and eosin stainings. Immunohistochemistry was performed to detect α-smooth muscle actin, fibronectin and collagen I and III.

Results: Colectomy specimens from patients with acute UC showed significantly more inflammation than those with longstanding disease [19 vs 9 points, p = 0.01]. Both acute and longstanding UC showed a thicker muscularis mucosa than controls [0.10 vs 0.10 vs 0.05 mm, respectively, p = 0.019]. An increase in collagen I and III deposition in the mucosa was observed in UC compared with controls (40% [30-75] vs 25% [10-25], p = 0.033), but this did not differ significantly among acute and longstanding UC patients.

Conclusions: Collagen deposition is enhanced in UC compared with controls. However, UC collagen deposition does not increase significantly over time and does not seem to aggravate the entire fibrotic process.

Keywords: Ulcerative colitis; fibrosis; pathology.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Biomarkers / metabolism
  • Case-Control Studies
  • Chronic Disease
  • Colectomy
  • Colitis, Ulcerative / metabolism
  • Colitis, Ulcerative / pathology*
  • Colitis, Ulcerative / surgery
  • Colon / metabolism
  • Colon / pathology*
  • Colon / surgery
  • Colonic Neoplasms / metabolism
  • Colonic Neoplasms / pathology
  • Disease Progression
  • Fibrosis
  • Humans
  • Immunohistochemistry
  • Intestinal Mucosa / metabolism
  • Intestinal Mucosa / pathology*
  • Middle Aged
  • Retrospective Studies
  • Severity of Illness Index


  • Biomarkers