Challenges in the diagnosis of ulcerative colitis with concomitant bacterial infections and chronic infectious colitis

Abstract

Ulcerative colitis (UC) is a chronic inflammation of the large bowel characterized by diarrhea and a negative stool culture. However, several enteropathogens have been implicated as causative agents in UC. The differentiation between chronic infectious colitis (IC) and UC with concurrent infection is difficult owing to their similar clinical presentations. The study aimed to explore the presentations and diagnostic clues that enable differentiation between UC with concomitant infections and chronic IC. The study included 17 UC patients with a bacterial infection and 46 with chronic IC. The UC patients (47 ± 19 years) were younger than the chronic IC patients (58 ± 20 years) (P = 0.022). Bloody diarrhea was more common in UC than in chronic IC (58.8% vs 10.9%, P < 0.001). Previous antibiotic usage was a risk factor for chronic IC (5.9% vs 32.6%, P = 0.031). Malignancy was a common comorbidity of chronic IC (5.9% vs 34.8%, P = 0.022). UC patients had lower antibiotic response rates than chronic IC patients (60.0% vs 87.2%, P = 0.026). Aeromonas species and Clostridium difficile were common in both groups. Histological features of cryptitis and crypt abscess were useful in the diagnosis of UC (P = 0.052 and P = 0.016, respectively). Bloody diarrhea in a young adult, decreased response to antibiotic treatment, and results of endoscopy with biopsy are important features in the diagnosis of UC with bacterial infection.

Incidence and Prevalence of Inflammatory Bowel Disease across Asia

“… 49 However, there are many efforts to improve awareness about IBD and to improve access to medical services to differentiate acute infectious colitis from IBD. 52 Nevertheless, more than 300000 Indians are estimated to have CD, and 1.1 million people have UC in India. Because of the large population of India, with more than 120 million, the total IBD burden of India could be highest in the world.…”

Focal Active Colitis Presented With Chronic Diarrhea

“…Chronic diarrhea sometimes can be a very challenging clinical scenario due to multitude of differential diagnoses to consider. The majority of the macroscopic findings during endoscopic evaluation are unremarkable or nonspecific [9]. Greenson et al in their study on adult population reported that endoscopic findings of FAC varied.…”

Inflammatory bowel disease masquerading as traveller's diarrhoea

“…A recent retrospective study by Lin et al . sought to identify features that could be used to differentiate these two clinical entities . Young age, bloody diarrhoea, poor antibiotic response and cryptitis together with crypt abscesses on histology were found to be significant .…”

“…sought to identify features that could be used to differentiate these two clinical entities . Young age, bloody diarrhoea, poor antibiotic response and cryptitis together with crypt abscesses on histology were found to be significant . Considerable overlap has been noted between the clinical, endoscopic and histological features of infectious colitis and UC.…”