Abstract
Since macroscopic change in ulcerative colitis (UC) is known to be non-specific, endoscopic diagnosis of UC is mainly based on the location and continuity of the lesion, i. e., serial involvement from the rectum. To clarify whether macroscopic change charac-teristic of UC never exist or do exist, 55 cases of UC were examined in total of 156 times with a magnifying video endoscope Fujinon EVC-HM during 2 years 4 months. Macro-scopic lesions were compared with their pathohistological and mucohistochemical changes using 528 biopsy specimens. As controls, 91 biopsy specimens were also examined from 13 patients without colonic disease. mucohistochemical change of lesions were examined by the high iron diaminalcian blue staining (HID-AB). Magnifying video endoscope revealed amall yellow spots in active area of slight illness (Matts' grade 2), and in marginal zone between active and inactive areas of moderate to severe illness (Matts' grade 3 to 4). These spots disappeared with a remission after treatment and re-appeared with a recurrence. Pathohistologically these spots showed focal destruction of colonic glands with severe infiltration of neutrophils. Moreover, a focal area showing small yellow spots was not infrequently (41.8%) observed in oral-sided mucosa of the colon apart from the active area intervening normal mucasa A lesion like this was consistent with a "skip ped lesion." In the normal colon, colonic glands preferentially had sulphomucin. By contrast, colonic glands in active stage of UC preferentially had sialomucin. The rate of sialomucin expression was similar between active areas of UC and skip ped lesion, suggesting that skip ped lesion was mucohistochemically equivalent to active area of UC. The finding of small yellow spots seemed to be characteristic and could be an indicator suggesting UC in the endoscopic diagnosis. The existence of skip ped lesion as active colitis may ask need to revise the present classification of disease type in UC.
