ABSTRACT
Ulcerative colitis is characteristically a chronic intermittent disease of the large bowel mucosa. Less commonly, symptoms are low grade and continuous (Moum et al., 1997a). Rarely, patients suffer only a single attack (Edwards and Truelove, 1963). This chapter is based on the assumption that the disease has a characteristic histological appearance which develops during its course. In general this allows a confident biopsy diagnosis to be made in established disease but usually only a suggested diagnosis at the initial presentation (Goldman and Antonioli, 1982; Therkildsen et al., 1989) when a distinction from infectious colitis [acute self-limiting colitis (ASLC)] or Crohn’s disease is the commonest diagnostic dilemma confronting
the pathologist (Chapters 4 and 6). Moum et al. (1997b) found up to 10 per cent of patients initially thought to have chronic inflammatory bowel disease needed reclassification. The development of a characteristic pattern over a variable period makes sequential biopsy part of the diagnostic work-up (Goldman, 1994; Schumacher et al., 1994a; Geboes, 2001). Because of the inherent prolonged and paroxysmal nature of ulcerative colitis it is best to avoid the labels ‘acute’ and ‘chronic’ but to consider the disease in terms of three phases; active, resolving and in remission (quiescent). We feel the term ‘acute colitis’ should be restricted to clinical use and has no pathological specificity.
