Radiological Appraisal of Extent of Disease in Ulcerative Colitis

Abstract

Radiological findings obtained by double contrast barium enema in 82 patients with ulcerative colitis, who were longitudinally followed for one to 15 years, were evaluated to estimate the extent of the disease, to trace a longitudinal change in the extent of disease, and to correlate the extent of the disease with prognosis. The following conclusions were reached. 1. The findings of oral end of the disease were classified into two groups, in the 24 patients who were examined at the initial onset of the disease. Group A. There was an abnormal network pattern indicating a transitional zone between the normal portion and the main disease site in 15 of the 24 patients. The size of this zone ranged from 3 to 13 cm, (average 6.9 cm). Histological examination of biopsy specimen taken from this zone showed the infiltration of inflammatory cells, edema, or some cryptal abscesses. It was concluded that the portion with abnormal network pattern should be included also in the disease area. Group B. The diseased and normal areas were clearly distinct in these nine patients. The majority of the patients in this group had the disease to a slight degree only. 2. In 19 of the 63 patients who were followed long-term, the extent of the disease observed at the initial onset changed. The time interval needed for this change or the extent of change during observation remained uncertain. The change in extent of the disease was classified into three groups, (a) enlargement (five cases), (b) diminution (five), and (c) mixed (nine). 3. Three of the five patients with enlargement in extent were operated upon within 10 years after onset and the prognosis in this group was poor. No patient with diminished disease underwent surgery in a 10-year period of observation and the prognosis was good. Three of the nine patients with mixed changes had surgical treatment with-in 10 years of the disease onset, and the prognosis of this group was relatively good. 4. In one of the 15 patients with proctitis type the disease extended orally within 10 years of onset.