Ulcerative Colitis Differential Diagnosis Table

Ulcerative Colitis Differential Diagnosis Table:

Ulcerative colitis is a chronic inflammatory disease that causes bowel (large intestine) inflammation and ulcers. Ulcers are circumferential and continuous along the inner surface (mucosa and submucosa) of the large intestine.
Ulcerative colitis appears as bloody diarrhea with or without mucus, abdominal pain, especially in the left lower quadrant, fever, fatigue, urgency, and tenesmus. Ulcerative colitis is diagnosed through endoscopy, biopsy, and negative stool examination for infectious causes.

How to Distinguish Ulcerative Colitis from Other Diseases

Distinguish Infectious Colitis from Ulcerative Colitis – Diagnosis

Infectious colitis is an inflammation in the colon.

• Infectious colitis is associated with bacteria, viruses, or fungal infectious agents, while ulcerative colitis is not associated with an infectious agent.

“Stool microscopy and culture are used for differentiation, in addition to endoscopy.”.

Distinguish Crohn’s Disease from Ulcerative Colitis – Diagnosis

Crohn’s disease is a type of chronic inflammatory bowel disease.

• Crohn’s disease causes ulceration in the whole abdominal lining, while ulcerative colitis causes ulceration in the colon only.
• Crohn’s disease causes abdominal pain, especially in the right lower quadrant, while Ulcerative colitis causes abdominal pain, especially in the left lower quadrant.
• Crohn’s disease is associated with narrowing and thickening of the bowel (transmural inflammation), while Ulcerative colitis is not associated with transmural inflammation.

“Endoscopy and blood tests are used for differentiation.”

Distinguish Infectious Enterocolitis from Ulcerative Colitis – Diagnosis

Infectious enterocolitis is inflammation in the bowel.

• Infectious enterocolitis is associated with an infectious agent, while ulcerative colitis is not associated with an infectious agent.
• Infectious enterocolitis involves the small and large intestines, while ulcerative colitis involves the large intestine only.

“Stool culture and endoscopy are used for differentiation.”

Distinguish Appendicitis from Ulcerative Colitis – Diagnosis

Appendicitis is acute inflammation of the appendix.

• Appendicitis is sudden localized pain in the right lower quadrant of the abdomen, while ulcerative colitis is pain in the abdomen, especially in the left lower quadrant.
• Appendicitis is associated with pain when pressure is applied (rebound tenderness) on the appendix, while ulcerative colitis is not associated with rebound tenderness.
• Appendicitis is not accompanied with diarrhea nor rectal bleeding, both of which are main signs of ulcerative colitis.

“Imaging such as CT and ultrasound are used for differentiation.”

Distinguish Ischemic Colitis from Ulcerative Colitis – Diagnosis

Ischemic colitis is reduced blood flow to the colon.

• Ischemic colitis is a comorbidity of cardiovascular disease, while ulcerative colitis is not associated with an underlying disease.
• Ischemic colitis is associated with transmural inflammation, which is absent in ulcerative colitis.

“Colonoscopy and barium enema are used for differentiation.”

Distinguish Celiac Disease from Ulcerative Colitis – Diagnosis

Celiac Disease is an autoimmune disease affecting the small intestine.

• Celiac is an autoimmune disease associated with gluten ingestion, while ulcerative colitis is not associated with food ingestion.
• Celiac disease is accompanied by a skin condition called “dermatitis herpetiformis,” while ulcerative colitis is not accompanied by skin manifestations.

“Serology test is used for differentiation.”

Distinguish Behçet’s Disease from Ulcerative Colitis – Diagnosis

Behcet’s disease is an auto-inflammatory disease affecting blood vessels.

• Behcet’s disease main manifestations are oral and genital ulcers, while ulcerative colitis does not affect oral or genital areas.
• Behcet’s disease is associated with ocular and musculoskeletal manifestations, which are both absent in ulcerative colitis.
• Behcet’s disease involves inflammation of lymph nodes, while ulcerative colitis does not involve lymph nodes..

Distinguish Gastrointestinal Lymphoma from Ulcerative Colitis – Diagnosis

Gastrointestinal lymphoma is a tumor affecting the digestive system.

• Gastrointestinal lymphoma affects the whole digestive tract, while ulcerative colitis affects the large intestine only.
• Gastrointestinal lymphoma involves dyspepsia, epigastric pain, nausea, and vomiting, which are all absent in ulcerative colitis.

“Endoscopy is used for differentiation.”

Ulcerative Colitis Red Flags and Treatment

Ulcerative colitis can lead to severe complications such as extensive bleeding and dehydration, perforation of the colon, and colon cancer.
Ulcerative colitis treatment depends on the severity of the disease. As a first line, anti-inflammatory drugs (sulfasalazine) are used. If the first line of treatment fails, the second line of treatment, immunosuppressive agents (corticosteroids), is proceeded. In severe cases, which failed all lines of treatment, a colectomy is considered, which is the removal of affected parts in the large intestine.