Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item The Role of the pathologist in the assessment of disease activity in ulcerative colitis(College of Pathologists of Sri Lanka., 2018) Mahendra, B.A.G.G.; Hewavisenthi, S.J.De S.ABSTRACT: In order to determine the role of the pathologist in assessing disease activity in UC, clinical and histological correlation of disease activity, correlation between endoscopy and histology and determining the most satisfactory method of scoring histological activity were assessed. A cohort of 41 patients attending a gastroenterology clinic in a tertiary hospital in Sri Lanka was studied. Their clinical activity was determined based on the simple clinical colitis activity index (SCCAI), endoscopically visible inflammation was recorded with reference to the extent of involvement and histology was assessed using three different histological scoring systems. The Spearman rank correlation coefficients between SCCAI and the three histological scoring systems were 0.298, 0.286, and 0.238 respectively denoting poor correlation. The kappa value of agreement between endoscopy and histology was poor (k=0.136). The Spearman rank correlation coefficients between the three histological scoring systems were 0.883, 0.883 and 0.952, reaching a level of statistical significance (p<0.01). The clinical activity and histological activity do not correlate and this is especially when assessing the more proximal colon. Endoscopy and histology also shows no correlation highlighting the importance of microscopic assessment of endoscopically normal mucosa. Finally, the histological scoring systems correlate fairly closely with one another enabling histopathologists to choose one that is most practical for routine use.Item Is Endoscopic examination alone adequate in determining the extent of disease in ulcerative colitis?(College of Surgeons of Sri Lanka, 2006) Mahendra, B.A.G.G.BACKGROUND : Endoscopic and histological examination of the mucosa are the mainstay in the diagnosis of ulcerative colitis. Assessing the extent of disease is important in the management of these patients. Sometimes an endoscopic examination alone is performed without biopsy and histological examination. OBJECTIVE: To compare the extent of disease in ulcerative colitis as assessed endoscopically versus that determined histologically. METHOD: 41 patients with ulcerative colitis were identified. In each of these patients endoscopy was performed and the appearance was recorded. In each patient 1-6 mucosal biopsies (mean - 3.2) were obtained for histological evaluation. A total of 136 biopsies were examined histologically and compared with the endoscopic appearance of the corresponding area of the bowel. The sensitivity of endoscopy in detecting the presence of true inflammation was also studied for the different regions of the bowel. RESULTS: 125 biopsies showed histological involvement. The endoscopy and histology were both positive in 68. The endoscopy was negative whilst the histology was positive in 57 biopsies. Endoscopy and histology were both negative in 10 biopsies and endoscopy alone was positive in only one biopsy.The kappa value of agreement was 0.136 denoting poor agreement between endoscopy and histology.Endoscopic examination had a high sensitivity in detecting proctitis. When more proximal regions of the bowel were biopsied, the sensitivity of endoscopic examination in detecting histological inflammation gradually declined. CONCLUSION: Since endoscopy and histology show poor agreement it is recommended that both should be performed to assess the true extent of disease in ulcerative colitis.