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Isolated colonic ulcers: diagnosis and management.
1Section of Digestive Diseases, Yale University School of Medicine, 333 Cedar Street, PO Box 208019, New Haven, CT 06520-8019, USA. anil.nagar@yale.edu
Current Gastroenterology Reports
|November 10, 2007
Summary
Isolated colonic ulcers, often found incidentally or causing symptoms like bleeding, can stem from NSAID use or other causes. Diagnosis involves biopsy, NSAID cessation, and ruling out inflammatory bowel disease.
Area of Science:
- Gastroenterology
- Colorectal Surgery
Background:
- Isolated colonic ulcers are distinct from colitis, presenting incidentally or with symptoms like abdominal pain, hematochezia, and bleeding.
- Common causes include nonsteroidal anti-inflammatory drug (NSAID) use, ischemia, solitary rectal ulcer syndrome (SRUS), radiation, and fecal impaction.
- Rare causes like stercoral ulceration and infections (tuberculosis, amebiasis) can lead to perforation.
Purpose of the Study:
- To review the causes, diagnosis, and management of isolated colonic ulcers.
- To highlight the importance of differentiating these ulcers from inflammatory bowel disease and malignancy.
Main Methods:
- Review of literature on isolated colonic ulcers.
- Discussion of diagnostic modalities including colonoscopy and histology.
- Outline of management strategies.
Main Results:
- NSAID-induced ulcers typically occur in the cecum and right colon.
- Rectal ulcers are associated with ischemia, SRUS, radiation, or impaction.
- Histology is crucial for excluding malignancy but diagnostic for SRUS and some infections.
Conclusions:
- An approach including biopsy, NSAID cessation, constipation management, and SRUS recognition is recommended.
- Inflammatory bowel disease must be excluded in relevant cases.
- Prompt diagnosis and management are essential to prevent complications like perforation.
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