A 29 y.o. patient has an acute episode of ulcerative colitis. What diagnostic test confirms this diagnosis?
A. Barium Swallow
B. Stool examination
C. Gastric analysis
D. Sigmoidoscopy
Correct Answer: D. Sigmoidoscopy
Sigmoidoscopy allows direct observation of the colon mucosa for changes, and if needed, biopsy. Colonoscopy or proctosigmoidoscopy might reveal loss of typical vascular pattern, granularity, friability, and ulceration which involve the distal rectum and proceed proximally in a symmetric, continuous, and circumferential pattern. The disease can range from disease isolated to the rectum and sigmoid colon (proctitis) to disease of the entire colon (pancolitis).
Option A: The barium swallow study, also known as a barium esophagogram or esophagram, is a contrast-enhanced radiographic study commonly used to assess structural characteristics of the entire esophagus. It may be used for the diagnosis of a wide range of pathologies including esophageal motility disorders, strictures, and perforations.
Option B: Diagnosis of ulcerative colitis is made clinically with supportive findings on endoscopy, biopsy, and by negative stool examination for infectious causes. Because colonic infection can produce clinical findings indistinguishable from idiopathic ulcerative colitis, microbiologic studies for bacterial infection and parasitic infestation should be included in the initial evaluation.
Option C: Gastric acid analysis is rarely done in current practice. When conducted, samples of stomach contents obtained via nasogastric tube are used to measure gastric acid output in a basal and stimulated state. This information may be useful in a patient who develops a recurrent ulcer after surgical vagotomy for peptic ulcer disease. In this case, a positive acid response to stimulation (sham feeding) indicates an incomplete vagotomy.
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