A Colonoscopic Study of Aphthoid Ulcers of the Large Intestine

Abstract

Colonoscopic characteristics of aphthoid ulcers in amebiasis, Crohn's disease, and tuberculosis were evaluated. Multiple aphthoid ulcers were featured in 14 out of 15 cases of amebiasis, 7 out of 74 cases of Crohn's disease, and 5 out of 24 cases of tuberculosis. Aphthoid ulcers of amebiasis were often confined to the rectum and lower sigmoid colon, being characterized by marginal elevation and erythema. Crohn's aphthoid ulcers lacked the red halo in all but one case. No verrucous elevations were observed. The intervening mucosa appeared intact in all cases. Aphthoid ulcers of intestinal tuberculosis were oval or lozenge‐shaped. They were surrounded by a marginal red halo in 4 cases (80%), however, the red halos found in tuberculosis patients were milder than those of patients with amebiasis. Aphthoid ulcers of Crohn's disease and tuberculosis showed a tendency to be arranged in a specific direction. Crohn's ulcers were arranged in a longitudinal fashion, whereas tuberculous ulcers were arranged in a circular fashion. Ulcers of amebiasis were arranged entirely at random. Biopsy from aphthoid ulcers of amebiasis showed parasites in 64%, whereas cytological studies were positive in 93% of cases.

Colonoscopic differences of erosive and/or small ulcerative lesions for diagnosis of colonic inflammatory diseases

“…Most patients (94.3%) with unknown etiology were assigned to group A or B, and the lesions were mainly seen in the rectum and the distal colon. On the other hand, 84.6% of patients with the infectious colitis were assigned to group C, and all of the lesions except amebic colitis and EHC were located in the whole or proximal colon 5,8,9 . Moreover, the distribution of the lesions in group C was in accordance with the specific distribution of each disease.…”

“…Because various etiologies and diseases may be related to erosions and/or small ulcers even if gross lesions are not included 4 . On the other hand, colonoscopy has increasingly become a routine examination, and early exact diagnosis is considered to be important to perform effective medical treatment 5 . However, few investigators report endoscopic differential diagnosis of colonic inflammatory diseases with erosive and/or small ulcerative lesions 4–6 .…”

“…On the other hand, colonoscopy has increasingly become a routine examination, and early exact diagnosis is considered to be important to perform effective medical treatment 5 . However, few investigators report endoscopic differential diagnosis of colonic inflammatory diseases with erosive and/or small ulcerative lesions 4–6 . In this study, we reviewed differential diagnosis of colonic inflammatory diseases based on the endoscopic morphology of these lesions.…”

“…However, we have many difficulties in assessing the etiology using colonoscopy, because various kinds of colitis and/or ileitis are known to show only erosive and/or small ulcerative lesions without gross appearance early and during the course of the disease. Although the role of mucosal biopsy and culture of biopsy specimens in acute colonic inflammatory diseases and idiopathic inflammatory bowel diseases have been described in several studies, 1–3 few investigators report on differential diagnosis of colonic inflammatory diseases using colonoscopy 4–6 . To investigate the clinical significance of these lesions and their characteristics helpful for diagnosis, we reviewed differential diagnosis of colonic inflammatory diseases based on the endoscopic morphology of these lesions.…”