Q1 Describe the clinical and pathological diagnostic features that distinguish Inflammatory

bowel disease of autoimmune etiology from infectious colitis.

Infectious colitis typically presents with sudden onset of symptoms compared to an insidious
onset with inflammatory bowel disease; although inflammatory bowel disease can occasionally
be acute in onset. In infectious colitis there is early fever and more than six bowel movements
per day while in inflammatory bowel disease, these symptoms are gradual, there are fewer daily
bowel movements and fever when present is normally later in the course.

Both inflammatory bowel disease and infectious colitis present with arthropathy but other extra
intestinal symptoms like ocular symptoms (uveitis, iritis) and cutaneous manifestations
(erythema nodosum, apthous stomatitis) are more common with inflammatory bowel disease.

In blood tests; very high white blood count (leukamoid reactions) should raise the possibility of
Clostridium difficile associated disease (CDAD) although in inflammatory bowel disease the
WBC count is high is not greater than 50000cells/ul. Elevated serum markers of inflammation
(CRP, ESR) strongly favor a diagnosis of IBD, so does the anemia of chronic disease.

Increase in pANCA and ASCA (anti-saccharomyces cerevisiae antibodies) are associated with
inflammatory bowel diseases (IBD).

Infectious colitis often show patchy inflammation unlike the continuous inflammation with
ulcerative colitis and discrete linear ulcers of Crohn’s disease are rare with the infectious colitis.

Colorectal biopsy is the most helpful in distinguishing the IBD from infectious colitis.
Plasmacytosis in lamina propria extending to the mucosal base and crypt distortion are present
in IBD especially in ulcerative colitis while in the infectious colitis crypt architecture is normal.

Q2 What are the clinical and pathological differences between ulcerative colitis and Crohn’s
disease?

Both conditions are characterized by recurrent inflammation of the intestine however they are
different.

Ulcerative colitis is characterized by chronic inflammation of the colon and the rectum while in
crohn’s disease it is typically located in the terminal ileum but can discontinuously affect the
entire gastrointestinal system.
Typically the Crohn’s disease presents with non-bloody, chronic watery diarrhea although
microscopic bleeding might be present while ulcerative colitis presents with bloody diarrhea with
mucus.

Unlike ulcerative colitis, Crohn’s disease can cause macrocytic because of vitamin B12
deficiency. This is due to chronically inflamed ileum leading to vitamin B12 malabsorption.

Unlike the ulcerative colitis, Crohn’s disease may presents with abdominal mass due to
adhesions within the intestines that are caused by inflammation and is palpable in the RLQ. In
Crohn’s disease also the first signs of the disease are enterocutaneous fistula and abscesses
formation typically seen in the perianal region.

Extraintestinal symptoms are commoner in ulcerative colitis compared with Crohn’s disease
especially Primary sclerosing cholangitis which is less common is Crohn’s disease.

In blood studies, pANCA is positive in patients with ulcerative colitis in about 60-70% while it is
positive in patients with Crohn’s disease in about 10-40% of the cases; ASCA (anti-
saccharomyces cerevisiae antibodies) is positive in patients with Crohn’s disease in about 60-
70 % cases while it is positive in patients with ulcerative colitis in about 10-20% of the cases;
therefore patients with positive pANCA and negative ASCA show a strong indication of
ulcerative colitis while in a patient with positive ASCA and a negative pANCA suggest Crohn’s
disease.

Pattern of involvement in ulcerative colitis is ascending inflammation and always involves the
rectum. Beginning from the rectum spreading continuously and proximally throughout the colon;
while in Crohn’s disease, the inflammation is discontinuous and may affect the entire GIT.

In ulcerative colitis the inflammation involves the mucosa and the submucosa while Crohn’s
disease is characterized by transmural inflammation.

Q3. Describe the potential use of genomics and biologics for the management of inflammatory
bowel diseases.

Genome sequencing studies can be used in identification of protective variants that offers the
opportunity to identify drug targets; for instance, a loss of function variant in the RN186 gene
could be used, although theoretically in treatment of ulcerative colitis.
Genome sequencing also has a potential use in identification of genetic defects that lead to or
are likely to cause therapy resistance in IBD and permit curative use of hematopoietic stem cell
transplantation for example in patients with X-linked inhibitor of aptosis(XIAP) deficiency.

Identification of pathogenic genetic variants in IBD patients offers individualized treatment

pathways including the appropriate use of Hematopoietic stem cell transplantation, pathway
specific biologic therapies and informed use of elective surgery.

REFERENCES

Surawicz CM.Haggitt RC. Hussemann M, et al. Mucosal biopsy diagnosis of colitis: acute self-
limited colitis and acute idiopathic inflammatory bowel disease.

UpToDate.https://www.uptodate.com/contents/endoscopic-diagnosis-of-inflammatory-bowel-
disease.

Amboss.https://www.amboss.com/contents/crohn disease.