Skip to main content
Journal of Clinical Pathology logoLink to Journal of Clinical Pathology
. 1995 Aug;48(8):749–753. doi: 10.1136/jcp.48.8.749

Histological discrimination of idiopathic inflammatory bowel disease from other types of colitis.

N Le Berre 1, D Heresbach 1, M Kerbaol 1, S Caulet 1, J F Bretagne 1, J Chaperon 1, M Gosselin 1, M P Ramée 1
PMCID: PMC502803  PMID: 7560203

Abstract

AIMS--To assess the value of histology in diagnosing inflammatory bowel disease (IBD) in colorectal biopsy specimens. METHODS--Retrospective, double blind evaluation of colorectal biopsy specimens from 41 patients with colitis (28 with ischaemic colitis and 13 with acute self-limited colitis) and 84 patients with IBD (42 with Crohn's disease and 42 with ulcerative colitis). RESULTS--The features distinguishing IBD from other forms of colitis included distorted architecture, lymphocyte and plasma cell infiltrate, excess of polymorphonuclear leucocytes, polymorphonuclear cryptitis, crypt abscesses, and basal lymphoid aggregates. The features discriminating between Crohn's disease and ulcerative colitis included an irregular or villous surface, distorted architecture, decrease in mucus content, and polymorphonuclear cryptitis. Using multivariate analysis, 90% of patients with Crohn's disease and 71% of those with ulcerative colitis were correctly classified, the former being strongly defined by epithelioid granulomas, microgranulomas and isolated giant cells, and the latter best defined by an irregular or villous surface, decrease in mucus content and crypt atrophy. CONCLUSIONS--Examination of colorectal biopsy specimens is a reliable method for diagnosing IBD. In the absence of epithelioid granulomas, microgranulomas and isolated giant cells a diagnosis of Crohn's disease is based on the absence of histological criteria favouring ulcerative colitis. The histological spectrum of indeterminate colitis remains to be clarified.

Full text

PDF
750

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Allison M. C., Hamilton-Dutoit S. J., Dhillon A. P., Pounder R. E. The value of rectal biopsy in distinguishing self-limited colitis from early inflammatory bowel disease. Q J Med. 1987 Dec;65(248):985–995. [PubMed] [Google Scholar]
  2. Giard R. W., Hermans J., Ruiter D. J., Hoedemaeker P. J. Variations in histopathological evaluation of non-neoplastic colonic mucosal abnormalities; assessment and clinical significance. Histopathology. 1985 May;9(5):535–541. doi: 10.1111/j.1365-2559.1985.tb02834.x. [DOI] [PubMed] [Google Scholar]
  3. Hyman N. H., Fazio V. W., Tuckson W. B., Lavery I. C. Consequences of ileal pouch-anal anastomosis for Crohn's colitis. Dis Colon Rectum. 1991 Aug;34(8):653–657. doi: 10.1007/BF02050345. [DOI] [PubMed] [Google Scholar]
  4. Jones J. H., Lennard-Jones J. E., Morson B. C., Chapman M., Sackin M. J., Sneath P. H., Spicer C. C., Card W. I. Numerical taxonomy and discriminant analysis applied to non-specific colitis. Q J Med. 1973 Oct;42(168):715–732. [PubMed] [Google Scholar]
  5. Koltun W. A., Schoetz D. J., Jr, Roberts P. L., Murray J. J., Coller J. A., Veidenheimer M. C. Indeterminate colitis predisposes to perineal complications after ileal pouch-anal anastomosis. Dis Colon Rectum. 1991 Oct;34(10):857–860. doi: 10.1007/BF02049696. [DOI] [PubMed] [Google Scholar]
  6. Landis J. R., Koch G. G. The measurement of observer agreement for categorical data. Biometrics. 1977 Mar;33(1):159–174. [PubMed] [Google Scholar]
  7. McCormick D. A., Horton L. W., Mee A. S. Mucin depletion in inflammatory bowel disease. J Clin Pathol. 1990 Feb;43(2):143–146. doi: 10.1136/jcp.43.2.143. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Price A. B. Overlap in the spectrum of non-specific inflammatory bowel disease--'colitis indeterminate'. J Clin Pathol. 1978 Jun;31(6):567–577. doi: 10.1136/jcp.31.6.567. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Riddell R. H., Goldman H., Ransohoff D. F., Appelman H. D., Fenoglio C. M., Haggitt R. C., Ahren C., Correa P., Hamilton S. R., Morson B. C. Dysplasia in inflammatory bowel disease: standardized classification with provisional clinical applications. Hum Pathol. 1983 Nov;14(11):931–968. doi: 10.1016/s0046-8177(83)80175-0. [DOI] [PubMed] [Google Scholar]
  10. Schumacher G., Kollberg B., Sandstedt B. A prospective study of first attacks of inflammatory bowel disease and infectious colitis. Histologic course during the 1st year after presentation. Scand J Gastroenterol. 1994 Apr;29(4):318–332. doi: 10.3109/00365529409094843. [DOI] [PubMed] [Google Scholar]
  11. Schumacher G., Sandstedt B., Möllby R., Kollberg B. Clinical and histologic features differentiating non-relapsing colitis from first attacks of inflammatory bowel disease. Scand J Gastroenterol. 1991 Feb;26(2):151–161. doi: 10.3109/00365529109025025. [DOI] [PubMed] [Google Scholar]
  12. Surawicz C. M., Belic L. Rectal biopsy helps to distinguish acute self-limited colitis from idiopathic inflammatory bowel disease. Gastroenterology. 1984 Jan;86(1):104–113. [PubMed] [Google Scholar]
  13. Surawicz C. M., Haggitt R. C., Husseman M., McFarland L. V. Mucosal biopsy diagnosis of colitis: acute self-limited colitis and idiopathic inflammatory bowel disease. Gastroenterology. 1994 Sep;107(3):755–763. doi: 10.1016/0016-5085(94)90124-4. [DOI] [PubMed] [Google Scholar]
  14. Theodossi A., Spiegelhalter D. J., Jass J., Firth J., Dixon M., Leader M., Levison D. A., Lindley R., Filipe I., Price A. Observer variation and discriminatory value of biopsy features in inflammatory bowel disease. Gut. 1994 Jul;35(7):961–968. doi: 10.1136/gut.35.7.961. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Journal of Clinical Pathology are provided here courtesy of BMJ Publishing Group

RESOURCES