Ulcerative Colitis in Children Differential Diagnoses

  • Author: Judith R Kelsen, MD; Chief Editor: Carmen Cuffari, MD   more...
 
Updated: Sep 28, 2011
 
 

Diagnostic Considerations

Consider the following medical issues in making a diagnosis:

  • Pseudomembranous (Clostridium difficile) colitis
  • Infectious colitis (due to Escherichia coli or Yersinia, Salmonella, or Shigella species)

Crohn disease

Colonoscopic findings more consistent with Crohn disease (CD) than with UC are sparing of the rectal mucosa, aphthous ulceration, and noncontiguous or skip lesions. When possible, visualizing the entire colon and the last portion of the ileum (terminal ileum) is critical, because the terminal ileum is not actively involved in UC but is commonly involved in CD. Noncaseating granulomas are diagnostic of CD.

ANCA is most commonly associated with UC but is present in only about 40% of patients with Crohn disease. ASCA is a serological marker that is more highly associated with CD, being present in 60% of cases of CD but in only 12% of UC patients.

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Judith R Kelsen, MD  Clinical Instructor in Pediatrics, University of Pennsylvania School of Medicine; Attending Physician, Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia

Judith R Kelsen, MD is a member of the following medical societies: American Academy of Pediatrics, American Association for the Study of Liver Diseases, American Gastroenterological Association, and North American Society for Pediatric Gastroenterology, Hepatology and Nutrition

Disclosure: Nothing to disclose.

Coauthor(s)

Petar Mamula, MD  Associate Professor, Department of Pediatrics, Division of Gastroenterology and Nutrition, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine

Petar Mamula, MD, is a member of the following medical societies: American Academy of Pediatrics, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, and North American Society for Pediatric Gastroenterology and Nutrition

Disclosure: Nothing to disclose.

Specialty Editor Board

Jorge H Vargas, MD  Professor of Pediatrics and Clinical Professor of Pediatric Gastroenterology, University of California, Los Angeles, David Geffen School of Medicine; Consulting Physician, Department of Pediatrics, University of California at Los Angeles Health System

Jorge H Vargas, MD is a member of the following medical societies: American Liver Foundation, American Society for Gastrointestinal Endoscopy, American Society for Parenteral and Enteral Nutrition, Latin American Society of Pediatric Gastroenterology, Hepatology & Nutrition, and North American Society for Pediatric Gastroenterology and Nutrition

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

David A Piccoli, MD  Chief of Pediatric Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia; Professor, University of Pennsylvania School of Medicine

David A Piccoli, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American Gastroenterological Association, and North American Society for Pediatric Gastroenterology and Nutrition

Disclosure: Nothing to disclose.

Chief Editor

Carmen Cuffari, MD  Associate Professor, Department of Pediatrics, Division of Gastroenterology/Nutrition, Johns Hopkins University School of Medicine

Carmen Cuffari, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors Jonathan E Markowitz, MD, Robert Baldassano, MD, David A Piccoli, MD, and Liz D Dancel, MD, to the development and writing of a source article.

References

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  3. Vasiliauskas E. Serum immune markers in inflammatory bowel disease. Gastroenterology and Endoscopy News [serial online]. Available at http://www.gastroendonews.com.

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  8. Eliakim R, Fischer D, Suissa A, et al. Wireless capsule video endoscopy is a superior diagnostic tool in comparison to barium follow-through and computerized tomography in patients with suspected Crohn's disease. Eur J Gastroenterol Hepatol. Apr 2003;15(4):363-7. [Medline].

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  10. Miele E, Pascarella F, Giannetti E, Quaglietta L, Baldassano RN, Staiano A. Effect of a probiotic preparation (VSL#3) on induction and maintenance of remission in children with ulcerative colitis. Am J Gastroenterol. Feb 2009;104(2):437-43. [Medline].

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  12. Mamula P, Markowitz JE, Brown KA, Hurd LB, Piccoli DA, Baldassano RN. Infliximab as a novel therapy for pediatric ulcerative colitis. J Pediatr Gastroenterol Nutr. Mar 2002;34(3):307-11. [Medline].

  13. Eidelwein AP, Cuffari C, Abadom V, Oliva-Hemker M. Infliximab efficacy in pediatric ulcerative colitis. Inflamm Bowel Dis. Mar 2005;11(3):213-8. [Medline].

  14. Becker JM. Surgical therapy for ulcerative colitis and Crohn's disease. Gastroenterol Clin North Am. Jun 1999;28(2):371-90, viii-ix. [Medline].

  15. [Guideline] Cohen JL, Strong SA, Hyman NH, Buie WD, Dunn GD, Ko CY, et al. Practice parameters for the surgical treatment of ulcerative colitis. Dis Colon Rectum. Nov 2005;48(11):1997-2009. [Medline].

  16. Sarigol S, Wyllie R, Gramlich T, Alexander F, Fazio V, Kay M, et al. Incidence of dysplasia in pelvic pouches in pediatric patients after ileal pouch-anal anastomosis for ulcerative colitis. J Pediatr Gastroenterol Nutr. Apr 1999;28(4):429-34. [Medline].

 
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Ulcerative colitis. Specimen from colectomy reveals diffusely hemorrhagic granular mucosa in a continuous distribution.
Histological section: diffuse inflammatory process, limited to mucosa and superficial portion of the submucosa (full thickness biopsy,staining, magnification).
Histological section: diffuse inflammatory process, limited to mucosa and superficial portion of the submucosa (full thickness biopsy,staining, magnification).
 
 
 
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