The Role of the Pathologist in Ulcerative Colitis

Abstract

Pathologists have an essential and wide role in the management of patients with ulcerative colitis (UC) which is a chronic inflammatory disorder of the bowel with remissions and relapses. The initial diagnosis of UC itself is challenging as the histological features vary widely with the clinical phase of the disease. Differentiating UC from other types of acute and chronic colitis, especially Crohn’s disease is crucial in the management. Understanding the characteristic morphological features of UC as well as unusual morphological features of the disease are important in this task. The histological disease activity has now been identified as important in therapeutic decisions. There are several histological activity indices in UC and currently, the Nancy histological index has been recommended to be used in daily clinical practice. Identifying dysplasia associated with UC and its grading is a challenging task for the pathologist and it is a crucial step in the surveillance and management of this chronic disease.