Comparative Features and Course of Ulcerative and Granulomatous Colitis

Abstract

The course of 95 patients was reviewed to evaluate criteria used to distinguish ulcerative and granulomatous colitis and to determine the effects of operation. Histologic criteria useful in separation of the two forms of colitis were the depth of mucosal ulceration and inflammation and the presence of sinus tracts and granulomas. The presence of microscopic sinuses or granulomas (or both) correlated significantly with clinical features considered those of granulomatous colitis, and their absence with clinical features of ulcerative colitis (p less than 0.005), but there was overlap in about a quarter of the cases. Patients with clinical and microscopical features considered typical of granulomatous colitis tended to require more ileostomy revisions, but the long-term course after total colectomy and ileostomy was similar for both forms of colitis. The distinction between ulcerative and granulomatous colitis has been too sharply drawn, and the unfavorable prognosis commonly ascribed to the granulomatous form is not proved.