What to expect from an ulcerative colitis histology

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Doctors can use histology during a person’s diagnosis, treatment, and remission from UC. Looking at tissue samples from the large intestine can help doctors track the progress of a person’s disease.

Doctors take tissue samples for histopathological use via a biopsy. A biopsy is when a doctor removes a small sample of tissue to test it for certain diseases.

If a person has UC, doctors may take a biopsy from the lining of their large intestine. A doctor may take a biopsy while they are performing a colonoscopy. Biopsies taken during colonoscopies are unlikely to cause pain, as there are no pain receptors on the internal lining of the colon.

A colonoscopy is a procedure that involves a doctor inserting a tube with a light and a camera on it, called an endoscope, into a person’s anus. Doctors use it to examine the lining of a person’s colon or rectum. They often use colonoscopies alongside histology to determine the severity of a person’s UC.

A histopathologist assesses UC tissue samples using a histologic scoring index. This index helps the histopathologist determine the severity of a person’s UC. Histologic scoring indexes help to assess:

• the severity of inflammation
• the strength of the intestinal lining
• damage to the colonic crypts, which are glands in the intestine

When a person has UC, it will either be active or in remission. Active UC means a person is experiencing symptoms, whereas remission means the disease is no longer causing issues. If a person has active UC, a histopathologist may expect to see:

• the presence of white blood cells inside the intestinal tissues, which indicates an attack from the immune system
• injury to the wall of the intestine from white blood cells
• shortening or branching of the colonic crypts
• Paneth cell metaplasia, which is when cells usually found on the right side of the colon are found on the left side, indicating long-term damage

A histopathologist should see similar damage to different tissue samples belonging to a person with UC.

Histological samples can help a histopathologist determine how severe a person’s UC is:

• A person with mild UC may have white blood infiltration and crypt abscesses in less than 50% of colonic crypts.
• A person with moderate UC may have infiltration and abscesses in more than 50% of crypts.
• A person with severe UC may have open lesions and erosion on their intestinal wall.

Along with biopsy and endoscopies, a doctor may use other methods to diagnose a person with UC.

Methods doctors use to diagnose UC include:

Medical and family history

A doctor may ask a person about their medical and family history during a UC diagnosis. They may ask if a person has any symptoms of UC, which include:

• diarrhea
• passing blood or rectal bleeding
• cramps or abdominal pain
• passing mucus or pus with stool
• having the urge to pass stool even though the bowels are empty
• urgently needing to have a bowel movement
• fatigue
• weight loss
• fever
• nausea
• vomiting

UC may sometimes run in families. A doctor might ask a person if anyone else in their family has UC.

Physical exams

A physical exam for UC may involve a doctor:

• checking a person’s heart rate, temperature, and blood pressure
• using a stethoscope to listen to a person’s abdomen
• pressing a person’s abdomen for signs of tenderness or any lumps
• inserting a finger into a person’s rectum to check for blood in their stool

Stool tests

If a person requires a stool test, a doctor will give them a container for their sample. The person will also receive instructions on how to provide their stool sample.

A doctor may use a stool test to check for signs of inflammation. They can also use a stool test to look for signs of other conditions that may be causing a person’s symptoms.

Blood tests

During a blood test for UC, a healthcare professional will take a sample of a person’s blood.

They will then send the blood sample to a lab where medical professionals will check the sample for complications of UC, such as anemia. They may also use the blood test to check for signs of infection.

Once a person receives a diagnosis of UC, a doctor can treat the condition in a variety of ways. The kind of treatment a person receives can depend on the severity of their UC. Treatment for UC includes:

Medication

The aim of UC medication is to bring a person’s UC into remission. Medications for UC that help reduce inflammation can include:

• aminosalicylates, which treat mild to moderate UC or help a person stay in remission
• immunosuppressants, which treat moderate to severe UC and help a person stay in remission
• biologics, which treat moderate to severe UC and help remission
• a novel small molecule medicine, which doctors use in moderate to severe UC cases when a person cannot take other medications
• corticosteroids, which treat moderate to severe UC cases, or for people who cannot use aminosalicylates

People usually use corticosteroids for a limited period to control inflammation quickly, after which they taper off their use. In some cases, people may not be able to come off of steroids. However, this is not common.

Surgery

Surgery for UC usually involves a surgeon removing a person’s colon and rectum. A doctor may recommend a person have surgery for UC if they have:

• colorectal cancer
• precancerous cells for colorectal cancer
• life threatening complications
• no improvement in symptoms after taking medication
• symptoms that only improve with corticosteroids, which people should not take on a long-term basis

The most common types of surgery a person may have for UC are:

Ileoanal reservoir surgery

After removing a person’s colon and rectum, a surgeon creates a pouch from the end of the small intestine. This pouch will collect the person’s stool, which they can pass during bowel movements.

Ileostomy

During an ileostomy, the surgeon removes a person’s colon and rectum, then attaches the end of their small intestine to an opening in their abdomen. This opening is known as a stoma. When a person has a bowel movement, it will pass through the stoma. The bowel movement collects in a bag attached to the stoma, called an ostomy bag.

Surgery is the only cure for UC. However, people with UC can manage their symptoms with treatment.

Additionally, a person who receives treatment can go into remission. This means that they do not experience symptoms of UC.

To stay in remission, a person may have to take medication for the rest of their life.

Ulcerative colitis (UC) is a condition that affects a person’s large intestine. There are various ways a doctor can diagnose a person with UC. They can use histology, which studies microscopic tissue structures, to diagnose and monitor UC.

Histopathologists can look at a tissue sample taken via biopsy from a person who has UC. The histopathologist can use this sample to check the severity and progression of a person’s UC.

A doctor can treat the condition with medication or surgery. Doctors cannot cure UC without surgery, but people can go into remission with treatment.