What are typical endoscopic findings in ulcerative colitis?

• A. Skip lesions with cobblestoning
• B. Normal mucosa with inflammatory polyps in sigmoid
• C. Continuous mucosal erythema, friability, superficial ulcers, and pseudopolyps starting from the rectum
• D. Isolated deep ulcers in the ileum

Answer: (C)

In ulcerative colitis, the endoscopic picture is a continuous inflammation of the colon that starts in the rectum and extends upward without skipping areas. The mucosa appears red and easily fragile, with superficial ulcers and regenerative projections called pseudopolyps. This combination—continuous involvement beginning at the rectum, mucosal erythema and friability, shallow ulcers, and pseudopolyps—is classic for UC because it reflects mucosal, rather than transmural, inflammation limited to the colon.

The other patterns don’t fit UC as well. Skip lesions with cobblestoning point to Crohn disease, where inflammation appears in patchy segments and can affect any part of the GI tract with deeper, transmural ulcers. Seeing deep ulcers isolated to the ileum suggests Crohn’s disease rather than UC. Normal mucosa with inflammatory polyps in the sigmoid could occur in chronic inflammation, but UC characteristically shows continuous mucosal changes starting from the rectum, not a normal mucosa with isolated polyps.