Is pan-colitis a definitive diagnosis?

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Another UC Mum
New Member

Date Joined Apr 2018
Total Posts : 17
   Posted 6/14/2018 6:39 AM (GMT -6)   
Hi All

I was wondering if I could ask for some help translating my daughter’s biopsy results from January (only just received), I just wondered if she definitely has been diagnosed with Ulcerative Colitis or not really. She was admitted to hospital in January after a month of tummy pain, constipation and blood towards the end (more than I would like to see but nowhere near as I have head described on this forum), she didn’t really suffer too much with diarrhea but again she did have some not long before admittance to hospital, BMs were sporadic even at the worst (like one day 5 five with diarrhea and then didn’t go the next day etc) but no urgency or accidents. I am probably wishful thinking but I am just a little confused. She has been completely symptom free since coming off prednisone in May and after her April bloods I was asked to reduce her pentasa from 2g per day (+ 1g enema at night) to 1g per day (+ 1g enema at night) as her lymphocytes were dropping but there was no inflammation detected in either her blood or stool sample, it just strikes me as odd if she has severe pan colitis why everything seems to have gone so quiet and meds dropped so much, or do you think it may mean her just don’t suit her and we may have to move up to immunosuppressant’s (even though she is currently symptom free). After her colonoscopy her doctor said on sight it was severe pan colitis. We are based in the UK so I don’t know if that makes a difference.

Sorry I can’t cut and paste but her biopsy showed:

Pot C: D2
Biopsy: Duodenal mucosa with normal villous architecture and no excess of inflammatory cells in the lamina propria. There is no increase in intraepithelial lymphocytes. No granulomas or organisms are seen. There is no evidence of dysplasia or malignancy.

Pot D: Transverse x 1
Pot E: Descending Colon x 2
Pot F: Sigmoid x 2
Pot G: Rectum x2

Biopsy for D-G: sections show moderate acute-on-chronic inflammation of the lamina propria, mild crypt distortion, cryp abscess formation and cryptitis. Ulcer Slough is present. No evidence of dysplasia or malignancy.

Conclusion: mild gastritis and moderate pan-colitis in keeping with ulcerative colitis.


Is this a definitive ulcerative colitis diagnosis?
Has this been downgraded from Severe to moderate?
What is a D2?
What does acute-on-chronic mean?

Thank you in advance, this forum has been so helpful in the past! As I said I am probably wishful thinking but I would be interested in your thoughts…..
12 year old daughter dx with moderate to severe pancolitis (into the transverse at least) in January 2018.
Current meds
2 x Pentasa
1 x 1g SolaFalk enema daily
1 x probiotic

Veteran Member

Date Joined Feb 2011
Total Posts : 748
   Posted 6/14/2018 7:05 AM (GMT -6)   
Hi UC Mum,

Always sad when a young kid has to suffer. Glad you are there for her.

It does seem she has UC from the report. Whether it is moderate or severe is open to interpretation when seen visually, as opposed to analyzing biopsies in the lab.

D2 means second part of duodenum. They must have done an upper endoscopy (which is usually quick) before looking at the large bowel. All seems ok there.

Chronic disease means long term, whereas acute means a recent event. 'Acute-on-chronic' refers to some active illness on top of chronic (long term) changes.

The report doesn't sound too bad, overall. She has some chronic changes (which is to be expected) and some recent acute activity.

It's great that she's been symptom free. They may decide to increase the pentasa again?

Wish you good luck.

Veteran Member

Date Joined Feb 2011
Total Posts : 4157
   Posted 6/14/2018 9:25 AM (GMT -6)   
it is good news that the bioposies supported moderate when the visual suggested severe.

pancolitis often resolves to left sided early on because the right and transverse colon are the easiest to treat with oral mesalamine

some maintence/long-term use of mesalamine and continued use of the SolaFalk for now is a good idea. Over time the SolaFalk use might be tapered to less frequency.

if after some time there is resistant left-side or sigmoid UC, then a stronger med could be considered.

for the moment, time, may be the best med
11/08: ischemic colitis and scope perf colon. 12cm colon/ileocecal resected. IV antib:sepsis.
01/10: Dx: Mod. UC pancolitis. Rx: Lialda 3x.
02/11: Major flare w/antib:sinus. Rx: 40mg Pred taper. 6mp.
07/11: Histol remiss rt/trans; worse sigmoid. Rx: Rowasa & hydrocort
Curr: 1-2 soft-formed stool, no urgency: Lialda 2x, NO PRED, probiotics, Vit-D/C

Forum Moderator

Date Joined Aug 2012
Total Posts : 12973
   Posted 6/14/2018 10:00 AM (GMT -6)   
Sure glad to help translate the medical jargon.
Another UC Mum said...
Pot C: D2
Biopsy D2: Her duodenum is the first part of the small intestine, just past the stomach and it appeared 100% normal, with nothing unusual found. This was taken during upper-endoscopy.

Pot D: Transverse x 1 (1 sample taken in the horizontal part of the large intesine)
Pot E: Descending Colon x 2 (2 samples high up on the left side of large intestine)
Pot F: Sigmoid x 2 (1/2 way down the left side of large intestine)
Pot G: Rectum x2 (end of the left side of large intestine)

Biopsy for D-G:

Inflammation seen that has characteristics of both acute (infectious) and chronic inflammation. It's common to see acute changes in newly spread inflammation that has not been around long enough to have chronic changes. Chronic always trumps acute when both are seen, and chronic means an IBD like UC.

The inflammation was very shallow (affecting only the shallow lamina propria layer of intestinal tissue), which is an important clinical finding for a UC diagnosis.

Chronic changes were mentioned earlier, but now we get into what exactly were the chronic changes seen. A normal large intestine's surface is like waves on a pond with high peaks and low valleys. In medical jargon, the valleys are known as crypts. Crypts are of special interest in UC diagnosis, as we almost always have permanent architectural changes to our crypts and that's rather distinct to just UC diagnosis. What did they see? The normal pattern of crypts was distorted; a permanent architectural change. The crypts were clogged with junk that did not belong there (abscesses made up of immune cells), and the crypts were inflamed (a cryptitis).

Ulcers are distinct to UC diagnosis (in the name Ulcerative Colitis) and they were seen.

Your daughter does NOT have colorectal cancer (No evidence of dysplasia/pre-cancer or malignancy/cancer).

Conclusion: mild gastritis and moderate pan-colitis in keeping with ulcerative colitis.

Is this a definitive ulcerative colitis diagnosis? Yes, for the reasons cited above. A misdiagnosis is very, very unlikely. What you describe is pretty much a storybook case of UC, and I'd say 99% odds that a second opinion from another doctor would full-heatedly agree with her current diagnosis. UC can rapidly go into a remission, and she's normal while in it. That's common, and expected of UC patients. We all do flare eventually, even when we are the posterchild for taking our medications daily and do everything we are all supposed to. Part of the definition of UC mentions periods of remission and flares, and that's exactly what was experienced.
Has this been downgraded from Severe to moderate?Not all the inflammation seen is directly due to UC. The prep from the colonoscopy can temporarily inflame a bit as well.
What is a D2?That's sample number D2, from the duodenum, just beneath the stomach.
What does acute-on-chronic mean?Both infectious/acute and chronic changes were seen. Recent inflammation looks acute, old inflammation looks chronic. Again, one mention of the word chronic trumps all mention of acute. The acute inflammation seen will become chronic after more time.

Moderator Ulcerative Colitis
, 40, UC Proctosigmoiditis
Rx: Remicade @5mgs/kg/6wks; daily 75mgs 6MP, 4.8g generic-Lialda, and rowasa

My reviews on Yelp and Trip Adviser will be terrible: @$10,000 a night with uncomfortable beds and awful food, but at least the drugs are good at this hospital.

Post Edited (iPoop) : 6/14/2018 9:06:03 AM (GMT-6)

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