It emphasizes that, although histopathological examin. A practical approach to colitis diagnostic histopathology. Crohns disease affects the small intestine and large intestine, as well as the mouth, esophagus, stomach and the anus, whereas ulcerative colitis primarily affects the colon and the rectum. Studies of pediatric inflammatory bowel disease ibd have varied in the criteria used to classify patients as having crohn disease cd, ulcerative colitis uc, or indeterminate colitis ic. Indeterminate colitis continues to be a controversial subject in some circles and might even be considered subjective.
The name indeterminate colitis is given when its unclear if a person has crohns disease or ulcerative colitis uc. Introduction indeterminate colitis is a term in common usage but which means different things to different people. The histopathological diagnosis of ulcerative colitis and the. A total of 525 cases of uc and 93 cases of ind yielded an mean annual incidence of. Pathology task force of the international organization of inflammatory bowel diseases. Price a framework is proposed for a comprehensive use of the term indeterminate colitis encompassing the whole spectrum of inflammatory bowel disease with division into two surgical resection patterns and two mucosal biopsy patterns. A framework is proposed for a comprehensive use of the term indeterminate colitis encompassing the whole spectrum of inflammatory bowel disease with division into two surgical resection patterns and two mucosal biopsy patterns. To assess differences in female sexual function by ibd diagnosis, disease activity, body mass index bmi, and steroid use oneway anova was used. Differentiating ulcerative colitis from crohn disease in. Gastrointestinal endoscopy biopsy derived proteomic patterns predict indeterminate colitis into ulcerative colitis and crohns colitis billy ray ballard, amosy ephreim mkoma billy ray ballard, department of pathology, meharry medical college school of medicine, nashville, tn 372083599, united states. Surgical pathology of ibd and its mimics maui, hi 2018 robert d. Ulcerative colitis uc is a chronic disease of unknown etiology characterized by inflammation of the mucosa and submucosa of the large intestine. Villanacci and wg 4 was on indeterminate, unclassified and infectious colitis related to ibd chaired by karel geboes and rami eliakim.
Why do we label uc as indeterminate or crohns disease from odze, mod pathol 2015. Incidence of ulcerative colitis and indeterminate colitis. Cases diagnosed as indeterminate colitis ind when endoscopy and histopathology were inconclusive or diverged with regard to diagnosis of uc or crohns disease cd were also included in the study. Indeterminate colitis should only be used in colectomy specimens as a provisional pathological diagnosis. Histological evaluation in ulcerative colitis gastroenterology report. The role of t helper cytokines in indeterminate colitis. Odze, md, frcpc chief, division of gi pathology professor of pathology brigham and womens hospital harvard medical school boston, ma indeterminate colitis 1. In 10% of cases of colitis, no differentiation can be made between cd and uc. The most common causes of uncertainty in ibd pathology that may lead to a diagnosis of ic in a colon resection specimen includes the. A contemporary and critical appraisal of indeterminate colitis nature. This latter observation suggests that ic may constitute a separate category within the spectrum of ibd. There is no consensus over its diagnosis and management, and uncertainty is compounded by the use of the same term to describe an idiopathic increase in colonic eosinophils and an. Indeterminate colitis broadening the perspective a. Mucosal lymphoid follicle extending towards the submucosa.
Indeterminate colitis diagnosis used for cases in which a definitive separation of ulcerative colitis and crohn disease cannot be made. Patients undergoing an initial evaluation for ibd will often undergo a series of diagnostic tests, including barium upper gastrointestinal series with small bowel followthrough, abdominal. Some researchers have made a case for indeterminate colitis to be considered a third form of ibd, while others maintain that it is a holding place until another diagnosis can be made. Inflammatory bowel disease, ulcerative colitis, crohns. The 2 most prevalent forms of inflammatory bowel disease ibd are ulcerative colitis uc and crohns disease cd. The variability of features with time and treatment and difficult differential diagnostic problems will be discussed. Although ileal pouchanal anastomosis ipaa is the standard of care surgery for patients with ulcerative colitis, the role of this procedure in patients with indeterminate colitis and crohns disease cd is more controversial. It is thought that around 15% of people with inflammatory bowel disease ibd are initially given this diagnosis crohns and uc are chronic lifelong conditions which are part of a group of conditions known as ibd. Crohn disease surgical pathology criteria stanford. European consensus on the histopathology of inflammatory. A 26yearold student was referred to the gastroenterology department by the general practitioner because of persistent rectal bleeding. Surgical pathology of ibd and its pathology cme from the.
Reports of eosinophilic colitisraised colonic mucosal eosinophil density in patients with lower gastrointestinal symptomshave increased markedly over the last fifteen years, though it remains a rarity. Indeterminate colitis journal of clinical pathology. Insufficient clinical, radiologic, endoscopic, pathologic info. The term is used for the classification of colitis when the evidence does not clearly point in the direction of one of the specific categories of idiopathic inflammatory bowel disease i. The term ibd was coined to cover two specific diseases. However, this term has suffered varying definitions, which in addition to numerous difficulties in diagnosing inflammatory bowel disease has led to much confusion. While most of these patients eventually evolve into patterns consistent with uc or cd, approximately 2060 % retain the diagnosis of indeterminate colitis ic over periods as long as 510 years post diagnosis. Histopathology can help to solve many diagnostic problems, especially when multiple biopsies of the colon. The separation of ulcerative colitis uc and crohns disease cd has been based on a variety of clinical features, symptoms, endoscopic and radiological, gross and microscopic characteristics that can be identified by clinical examination, radiologic and other scanning procedures, colonoscopy, and pathological examination of colectomy. The term indeterminate colitis has been used to describe cases of inflammatory bowel disease that cannot be classified as ulcerative colitis or crohns disease. He had had similar episodes 23 years previously but this had subsided.
The term indeterminate colitis should only be used in cases where a. This was not present all the time and his stools were of variable consistency. Rarer forms include lymphocytic colitis and collagenous colitis which tend to be referred to under the single term of microscopic colitis ibd is a chronic lifelong condition in which parts of the gastrointestinal tract the gut become inflamed. Ileal pouchanal anastomosis for indeterminate colitis and. Diagnosis of indeterminate colitis is suggested by. Indeterminate colitis is only a partial diagnosis, which is provisional until sufficient information becomes available for a more precise diagnosis of either ulcerative colitis or crohns disease. Histopathology of crohns disease and ulcerative colitis k. Request pdf pathology of indeterminate colitis the term indeterminate colitis ic is an interim, or preliminary, descriptive term used by pathologists for cases of inflammatory bowel disease. The role of endoscopy in inflammatory bowel disease.
Microrna expression patterns of indeterminate colitis provide molecular evidence indicating that most cases are probably ulcerative colitis, similar to the data from longterm clinical followup studies 5 15% of cases of inflammatory bowel disease. Patients with ulcerative colitis should receive an initial screening colonoscopy eight years after a diagnosis of pancolitis and 12 to 15 years after a diagnosis of leftsided disease, and then. Crohns disease and ulcerative colitis are the two most common forms of inflammatory bowel disease. In the absence of pathognomonic markers for crohns disease cd and ulcerative colitis uc, the diagnosis of inflammatory bowel disease depends on a compendium of clinical, radiographic, endoscopic, and histologic criteria that bears imperfect specificity to the individual disorders. European consensus on the histopathology of inflammatory bowel. Accurate histopathological assessment of biopsies is important for the diagnosis. The former is more common, being the final common pathway of fulminant colitis of several. Diagnostic problems and advances in inflammatory bowel disease. Crohns disease and ulcerative colitis are the principal types of inflammatory bowel disease. Almost always rectal involvement at disease onset but may develop rectal sparing and patchiness after treatment or chronic disease, resembling crohns colitis am j clin pathol 2004. Indeterminate colitis in resections may be of acute and nonacute type.
Recent studies have shown no significant adverse surgical outcome of ipaa in patients with indeterminate colitis. Section 3 chapter 18 disease and ulcerative colitis. Webmd explains how these inflammatory bowel diseases are alike and what sets each one apart. Tu1242 differential diagnosis between crohns disease and. Patients with indeterminate colitis appear to have a higher rate of pouch failure and longterm complications than those with uc. Indeterminate colitis broadening the perspective current. With long term followup, 80% of such cases are found to be ulcerative colitis. Diagnosis when cannot distinguish between crohn disease and ulcerative colitis j clin pathol 1978. Dysregulated immunity has been implicated in indeterminate colitis. May not be present in early uc, particularly in children. Shineng zhang professor department of gastroenterology sun yatsen university by 2. At presentation, the patient reported a 3month history of recurrent frank blood per rectum on defaecation.
Inflammatory bowel disease ibd is a group of inflammatory conditions of the colon and small intestine. Fulltext pdf indeterminate colitis broadening the perspective. A characteristic macroscopic appearance of the operative specimen with an uncertain histology. A contemporary and critical appraisal of indeterminate. The value of serologic markers in indeterminate colitis. Pseudomembranous colitis pmc is an acute colitis characterized by the formation of an adherent inflammatory membrane pseudomembrane overlying sites of mucosal injury. Clinically and histopathologically intractable disease should prompt close inspection and immunohistologic staining for cytomegalovirus. Together they account for more than 85% of all cases of ibd and are responsible for 1% of all colorectal cancers in the united states. Gastrointestinal endoscopy biopsy derived proteomic. A contemporary and critical appraisal of indeterminate colitis robert d odze 1 modern pathology volume 28, pages s30 s46 2015 cite this article. The latter mainly represent the overlapping pathology of active but medically controllable crohns disease and ulcerative colitis. Since ashley price in 1978 introduced the term indeterminate colitis ic to describe cases in which colonic resection had been conducted for chronic ibd where macroscopic and microscopic features were not sufficient to allow a definite diagnosis of either the classic type of ulcerative colitis uc or crohns disease cd, others have.
Inflammatory bowel disease, ulcerative colitis, crohns disease or. Extensively ulcerated cases may develop toxic megacolon. Crohns disease and ulcerative colitis can be easily confused. However, ic is increasingly used when a definitive diagnosis of uc or cd cannot be made at colonoscopy, in colonic biopsies or at colectomy. The distinction between ulcerative colitis and crohns disease has major implications.