We present a lesion-aware image captioning framework for ulcerative colitis (UC). The model integrates ResNet embeddings, Grad-CAM heatmaps, and CBAM-enhanced attention with a T5 decoder. Clinical metadata (MES score 0-3, vascular pattern, bleeding, erythema, friability, ulceration) is injected as natural-language prompts to guide caption generation. The system produces structured, interpretable descriptions aligned with clinical practice and provides MES classification and lesion tags. Compared with baselines, our approach improves caption quality and MES classification accuracy, supporting reliable endoscopic reporting.