Modern concept of differential diagnosis of colitis: from G.F. Lang to the present day. A review

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Abstract

The aim of the article is to improve the differential diagnosis of specific and nonspecific inflammatory bowel diseases. In Russia, this scientific direction is associated with the name of G.F. Lang, who performed in 1901–1902 the study „On ulcerative inflammation of the large intestine caused by balantidiasis“. The etiology of specific colitis is associated with infection with parasites, bacteria and viruses that cause inflammation of the intestinal wall, diarrhea, often with an admixture of mucus, pus and blood. Specific colitis (SC) may be accompanied by fever, abdominal pain, and tenesmus. Bacterial colitis is commonly caused by Salmonella, Shigella, Escherichia coli, Clostridium difficile, Campylobacter jejuni, Yersinia enterocolitica, and Mycobacterium tuberculosis. Viral colitis is caused by rotavirus, adenovirus, cytomegalovirus, and norovirus. Parasitic colitis can be caused by Entamoeba histolytica and balantidia. In gay people, SC can cause sexually transmitted infections: Neisseria gonorrhoeae, Chlamydia trachomatis, and treponema pallidum, affecting the rectum. Stool microscopy, culture, and endoscopy are used to establish the diagnosis. Stool culture helps in the diagnosis of bacterial colitis in 50% of patients, and endoscopic studies reveal only nonspecific pathological changes. Differential diagnosis of SC should be carried out with immune-inflammatory bowel diseases (ulcerative colitis, Crohn's disease, undifferentiated colitis), radiation colitis and other iatrogenic bowel lesions. The principles of diagnosis and therapy of inflammatory bowel diseases associated with various etiological 

About the authors

Asfold I. Parfenov

Loginov Moscow Clinical Scientific Center

Author for correspondence.
Email: asfold@mail.ru
ORCID iD: 0000-0002-9782-4860

доктор медицинских наук, профессор, зав. отдела патологии кишечника

Russian Federation, Moscow

Anna V. Kagramanova

Loginov Moscow Clinical Scientific Center; Research Institute of Healthcare Organization and Medical Management

Email: asfold@mail.ru
ORCID iD: 0000-0002-3818-6205

кандидат медицинских наук, ст. научный сотрудник отделения воспалительных заболеваний кишечника, ведущий специалист ГБУ НИИОЗММ

Russian Federation, Moscow; Moscow

Sergey G. Khomeriki

Loginov Moscow Clinical Scientific Center

Email: asfold@mail.ru
ORCID iD: 0000-0003-4308-8009

доктор медицинских наук, профессор, заведующий лаб. Патоморфологии

Russian Federation, Moscow

Dmitrii S. Kulakov

Loginov Moscow Clinical Scientific Center; Research Institute of Healthcare Organization and Medical Management

Email: asfold@mail.ru
ORCID iD: 0000-0002-0855-5217

мл. научный сотрудник отделения патологии кишечника, специалист организационно-методического отдела по колопроктологии ГБУ НИИОЗММ

Russian Federation, Moscow; Moscow

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2. Fig. 1. Early stages of ulcerative colitis. Crypt deformation, decreased number of glass cells, basal plasmocytosis. Dense inflammatory infiltration cells do not spread beyond the mucous membrane’s own plate. Hematoxylin and eosin coloration. ×120.

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3. Fig. 2. Crohn’s colon disease. Focal changes in the archtectonics of the intestinal crypt and the focal character of inflammatory infiltration with the spread of infiltration cells into the submicular layer. Granules in the mucous membrane are usually absent. Coloration with hematoxylin and eosin. ×120.

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4. Fig. 3. Infectious colitis. The presence of a large number of neutrophils between the cells of the surface epithelium, the destruction of the upper parts of the intestinal crypts and the hyperplasia of the lymphoid tissue of peyroid plaques with the formation of «typhoid nodules» resembling aphthoid ulcers. Coloration with hematoxylin and eosin. ×120.

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5. Fig. 4. Colon amebiase associated with E. histolytica: a – extensive tissue necrosis and erythrocytic clusters with few neutrophils and histiocytes, among which single trophozites can be distinguished at large; b – Trofozoites contain eccentrically arranged chromatin condensation (karyosoma), which looks like a black dot and makes it easier to distinguish from macrophages. Coloration with hematoxylin and eosin; a – ×120; b – ×500.

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6. Fig. 5. Colon hierosis associated with Y. pseudotuberculosis. Hyperplasia of lymphoid tissue, formation of non-necrotic epithelial cell granules and formation of characteristic intraepithelial lymphocytic microfollicles. Coloration with hematoxylin and eosin. ×300.

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7. Fig. 6. Neutropenic enterocolitis. Destruction of basal epithelium sections of intestinal crypts without significant inflammatory infiltration. Coloration of hematoxylin and eosin. ×300.

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