Ulcerative Colitis in Children Differential Diagnoses

Updated: Jul 26, 2019
  • Author: Judith R Kelsen, MD; Chief Editor: Carmen Cuffari, MD  more...
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Diagnostic Considerations

Consider the following medical issues in making a diagnosis:

  • Pseudomembranous (Clostridium difficile) colitis

  • Infectious colitis (due to Escherichia coli or Yersinia, Salmonella, or Shigella species)

Crohn disease

Colonoscopic findings more consistent with Crohn disease (CD) than with ulcerative colitis (UC) are sparing of the rectal mucosa, aphthous ulceration, and noncontiguous or skip lesions. When possible, visualizing the entire colon and the last portion of the ileum (terminal ileum) is critical, because the terminal ileum is not actively involved in UC but is commonly involved in CD. Noncaseating granulomas are diagnostic of CD.

Antineutrophil cytoplasmic antibody (ANCA) is most commonly associated with UC, but this serologic marker is present in only about 40% of patients with Crohn disease. Anti–Saccharomyces cerevisiae antibodies (ASCA) is a serologic marker that is more highly associated with CD, being present in 60% of cases of CD but in only 12% of UC patients.

Differential Diagnoses