Patchy cecal inflammation associated with distal ulcerative colitis: a prospective endoscopic study

Am J Gastroenterol. 1997 Aug;92(8):1275-9.


Objectives: It is generally believed that the mucosal inflammation in ulcerative colitis is characterized by a diffuse, continuous involvement starting from the rectum without "skip areas." It was the aim of this study to examine 20 patients with established "left-sided ulcerative colitis" prospectively by ileocolonoscopy with biopsies to determine the extent and the continuity of the mucosal inflammation and the incidence of skip lesions in ulcerative colitis.

Methods: Twenty patients with left-sided ulcerative colitis underwent a complete ileocolonoscopy with biopsies of the terminal ileum and all colonic segments. The patients remained in clinical follow-up for at least 8 yr after the initial examination.

Results: The upper margin of inflammation was sharply demarcated in 6 patients and gradual in 14. Segmental inflammation, separated from the distal inflamed segment by apparently uninvolved mucosa, was found in 15 patients (75%) and always included the area around the appendiceal orifice. The correlation between endoscopic abnormalities and histological changes was excellent.

Conclusion: In so-called "left-sided" ulcerative colitis distal involvement may be accompanied by more proximal areas of inflammation, particularly in the periappendiceal area of the cecum.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cecum / pathology*
  • Colitis, Ulcerative / diagnosis
  • Colitis, Ulcerative / drug therapy
  • Colitis, Ulcerative / pathology*
  • Colon / pathology
  • Crohn Disease / diagnosis
  • Diagnosis, Differential
  • Endoscopy, Gastrointestinal
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Proctitis / pathology
  • Prospective Studies
  • Rectum / pathology