Abstract
Diagnosis of the inflammatory bowel diseases ulcerative colitis (UC) and Crohn’s disease
(CD) relies mainly on the histopathological examination of endoscopic biopsies of
the gastrointestinal tract. To facilitate the accurate diagnosis of these two conditions,
this paper addresses key issues on the: (A) gastrointestinal biopsy procedure, (B)
histomorphological characteristics of UC and CD, and (C) diagnosis of dysplasia. The
13 statements presented here represent the consensus of two groups of Italian pathologists
(IG-IBD and GIPAD).
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Digestive and Liver DiseaseAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- A comprehensive review and update on ulcerative colitis.Dis Mon. 2019; (pii: S0011-5029(19)30031-8)
- A comprehensive review and update on Crohn’s disease.Dis Mon. 2018; 64: 20-57
- European consensus on the histopathology of inflammatory bowel disease.J Crohns Colitis. 2013; 7: 827-851
- The histopathological approach to inflammatory bowel disease: a practice guide.Virchows Arch. 2014; 464: 511-512
- The Sydney system: histological division.Gastroenterol Hepatol. 1991; 6: 209-222
- Histological evaluation in ulcerative colitis.Gastroenterol Rep (Oxf). 2014; 2: 178-192
- Multiple organ dysfunction in ulcerative colitis.Am J Gastroenterol. 2000; 95: 1258-1262
- Endoscopic biopsy samples of naïve “colitides” patients: role of basal plasmocytosis.J Crohns Colitis. 2014; : 1438-1443
- Morphologic criteria applicable to biopsy specimens for effective distinction of inflammatory bowel disease from other forms of colitis and of Crohn’s disease from ulcerative colitis.Scand J Gastroenterol. 1999; 34: 55-67
- Severe eosinophilic infiltration in colonic biopsies predicts patients with ulcerative colitis not responding to medical therapy.Colorectal Dis. 2014; 16: O420-30
- Colonic hypereosinophilia in ulcerative colitis may help to predict the failure of steroid therapy.Tech Coloproctol. 2018; 22: 941-946
- Inflammatory bowel disease.in: Jouret-Mourin A. Colitis. Springer, 2018 (p. 119)
- Eosinophilia-associated basal plasmacytosis: an early and sensitive histologic feature of inflammatory bowel disease.APMIS. 2017; 125: 179-183
- Inflammatory bowel disease biopsies: updated British Society of Gastroenterology reporting guidelines.J Clin Pathol. 2013; 66: 1005-1026
- European evidence-based consensus on the diagnosis and management of ulcerative colitis: definitions and diagnosis.J Crohns Colitis. 2008; 2: 1-23
- Histopathology predictors of medically refractory ulcerative colitis.Dis Colon Rectum. 2010; 53: 1280-1286
- Spatial distribution and histogenesis of colorectal Paneth cell metaplasia in idiopathic inflammatory bowel disease.J Gastroenterol Hepatol. 2001; 16: 1353-1359
- Mucin depletion in inflammatory bowel disease.J Clin Pathol. 1990; 43: 143-146
- Pathologic features and clinical significance of “backwash” ileitis in ulcerative colitis.Am J Surg Pathol. 2005; 29: 1472
- Letter: histological assessment of disease activity in ulcerative colitis—the problem of score evaluation and validation.Aliment Pharmacol Ther. 2016; 43: 438-439
- The emerging role of histologic disease activity assessment in ulcerative colitis.Gastrointest Endosc. 2018; 88: 887-889
- Prognostic value of histological activity in patients with ulcerative colitis in deep remission: a prospective multicenter study.United Eur Gastroenterol J. 2018; 6: 765-772
- Ulcerative colitis practice guidelines in adults (update): American College of Gastroenterology, Practice Parameters Committee.Am J Gastroenterol. 2004; 99: 1371-1385
- Histologic markers of inflammation in patients with ulcerative colitis in clinical remission.Clin Gastroenterol Hepatol. 2013; 11: 991-996
- Influence of treatment on morphological features of mucosal inflammation.Gut. 2002; 50 Suppl 3: III37-42
- Systematic review: histological remission in inflammatory bowel disease. Is “complete” remission the new treatment paradigm? An IOIBD initiative.J Crohns Colitis. 2014; 8: 1582-1597
- Microscopic activity in ulcerative colitis: what does it mean?.Gut. 1991; 32: 174-178
- Mucosal healing: impact on the natural course or therapeutic strategies.Dig Dis. 2009; 27: 470-475
- Non-IBD colitides: clinically useful histopathological clues.Rev Esp Enferm Dig. 2011; 103: 366-372
- Histological healing in inflammatory bowel disease: a still unfulfilled promise.World J Gastroenterol. 2013; 19: 968-978
- Assessing mucosal healing in ulcerative colitis: the simpler, the better.Endoscopy. 2015; 47: 759
- Review article: the histological assessment of disease activity in ulcerative colitis.Aliment Pharmacol Ther. 2015; 42: 957-967
- A reproducible grading scale for histological assessment of inflammation in ulcerative colitis.Gut. 2000; 47: 404-409
- Pathology of inflammatory bowel disease.Semin Pediatr Surg. 2007; 16: 154-163
- Histologic inflammation is a risk factor for progression to colorectal neoplasia in ulcerative colitis: a cohort study.Gastroenterology. 2007; 133: 1099-1105
- Development and validation of a histological index for UC.Gut. 2017; 66: 50-58
- Development and validation of the Nancy histological index for UC.Gut. 2017; 66: 43-49
- Histological remission in inflammatory bowel disease: where are we, and where are we going?.J Crohns Colitis. 2015; 9: 428
- Usefulness of different pathological scores to assess healing of the mucosa in inflammatory bowel diseases: a real life study.Sci Rep. 2017; 7: 6839
- Histopathology of ulcerative colitis in initial rectal biopsy in children.Am J Surg Pathol. 2002; 26: 1441-1449
- Inflammatory bowel disease in pediatric and adolescent patients: a biomolecular and histopathological review.World J Gastroenterol. 2014; 20: 10262-10278
- Patterns of inflammation in mucosal biopsies of ulcerative colitis: perceived differences in pediatric populations are limited to children younger than 10 years.Am J Surg Pathol. 2004; 28: 183-189
- Atypical rectosigmoid histology in children with newly diagnosed ulcerative colitis.Am J Gastroenterol. 1993; 88: 2034-2037
- Endoscopic and histological assessment of paediatric inflammatory bowel disease over a 3-year follow-up period.J Pediatr Gastroenterol Nutr. 2018; 66: 402-409
- Presenting features and disease course of pediatric ulcerative colitis.J Crohns Colitis. 2013; 7: e509-15
- Microscopic/“backwash” ileitis and its association with colonic disease in new onset pediatric ulcerative colitis.J Pediatr Gastroenterol Nutr. 2019; 68: 835-840
- Inflammatory pouch disease: the spectrum of pouchitis.World J Gastroenterol. 2015; 21: 8739-8752
- Restorative proctocolectomy with ileal reservoir: pathological and histochemical study of mucosal biopsy specimens.J Clin Pathol. 1987; 40: 601-607
- Patterns of distribution of endoscopic and histological changes in the ileal reservoir after restorative proctocolectomy for ulcerative colitis. A long-term follow-up study.Int J Colorectal Dis. 1998; 13: 103-107
- Distribution of mucosal pathology and an assessment of colonic phenotypic change in the pelvic ileal reservoir.Gut. 1993; 34: 101-105
- Inflammatory bowel disease.in: Noffsinger A.E. Fenoglio-Preiser’s gastrointestinal pathology. Wolters Kluwer, 2017 (p. 617)
- Pouchitis after ileal pouch–anal anastomosis: a pouchitis disease activity index.Mayo Clin Proc. 1994; 69: 409-415
- Refractory pouchitis: does it reflect underlying Crohn’s disease?.Gut. 1993; 34: 1539-1542
- Common inflammatory disorders and neoplasia of the ileal pouch: a review of histopathology.Gastroenterol Res. 2016; 9: 29-38
- Pouchitis after ileal pouch-anal anastomosis in ulcerative colitis: diagnosis, management, risk factors, and incidence.Dig Endosc. 2017; 29: 26-34
- Crohn’s disease.Lancet. 2017; 389: 1741-1755
- Chronic idiopathic inflammatory bowel diseases: the histology report.Dig Liver Dis. 2011; 43: S293-S303
- Simple mucosal biopsy criteria differentiating among Crohn’s disease, ulcerative colitis and other forms of colitis: measurement of validity.Scand J Gastroenterol. 2000; 35: 281-286
- Histopathological parameters as predictors for the course of Crohn’s disease.Virchow Arch. 2003; 443: 501-507
- The incidence of granulomas in serial sections of rectal biopsies from patients with Crohn’s disease.Acta Pathol Microbiol Immunol Scand A. 1982; 90: 145
- Epithelioid granulomas associate with increased severity and progression of Crohn’s disease, based on 6-year follow-up.Clin Gastroenterol Hepatol. 2018; 16: 900-907
- Myenteric plexitis is a risk factor for endoscopic and clinical postoperative recurrence after ileocolonic resection in Crohn’s disease.Dig Liver Dis. 2016; 48: 753-758
- Overlap, common features, and essential differences in pediatric granulomatous inflammatory bowel disease.J Pediatr Gastroenterol Nutr. 2010; 51: 690-697
- Identification of pathological features associated with “ulcerative colitis-like” Crohn’s disease.World J Gastroenterol. 2014; 20: 13139-13145
- ACG clinical guideline: management of Crohn’s disease in adults.Am J Gastroenterol. 2018; 113: 481-517
- A simple classification of Crohn’s disease: report of the Working Party for the World Congresses of Gastroenterology, Vienna 1998.Inflamm Bowel Dis. 2000; 6: 8-15
- Early mucosal changes in Crohn’s disease.Gut. 1993; 34: 375-381
- Histopathological findings of extra-ileal manifestations at initial diagnosis of Crohn’s disease-related ileitis.Virchows Arch. 2017; 470: 595-596
- Histopathological findings of extra-ileal manifestations at initial diagnosis of Crohn’s disease-related ileitis.Virchows Arch. 2016; 469: 515-522
- Perianal Crohn’s disease: a review.Postgrad Med. 2015; 127: 266-272
- Upper gastrointestinal tract involvement of pediatric inflammatory bowel disease: a pathological review.World J Gastroenterol. 2019; 25: 1928-1935
- Crohn’s disease of the esophagus, duodenum, and stomach.Clin Colon Rectal Surg. 2019; 32: 231-242
- Paediatric inflammatory bowel disease: review with a focus on practice in low- to middle-income countries.Paediatr Int Child Health. 2019; 39: 48-58
- Histological features in pediatric ileitis: is it possible to tip the balance towards Crohn’s disease?.Dig Liver Dis. 2018; 50: 154-155
- Histological features of ileitis differentiating pediatric Crohn disease from ulcerative colitis with backwash ileitis.Dig Liver Dis. 2018; 50: 147-153
- H-ECCO Group. Clinicopathological and molecular specificities of inflammatory bowel disease-related colorectal neoplastic lesions: the role of inflammation.J Crohns Colitis. 2018; 12: 1486-1498
- Precancerous lesions in inflammatory bowel disease.Best Pract Res Clin Gastroenterol. 2013; 27: 257-267
- Effect of medications on risk of cancer in patients with inflammatory bowel diseases: a population-based cohort study from Olmsted County, Minnesota.Mayo Clin Proc. 2015; 90: 738-746
- Colorectal cancer surveillance in inflammatory bowel disease: practice guidelines and recent developments.World J Gastroenterol. 2019; 25: 4148-4157
- Colorectal cancer in inflammatory bowel disease: the risk, pathogenesis, prevention and diagnosis.World J Gastroenterol. 2014; 20: 9872-9881
- The risk of colorectal cancer in ulcerative colitis: a meta-analysis.Gut. 2001; 48: 526-535
- Declining risk of colorectal cancer in inflammatory bowel disease: an updated meta-analysis of population-based cohort studies.Inflamm Bowel Dis. 2013; 19: 789-799
- Decreasing risk of colorectal cancer in patients with inflammatory bowel disease over 30 years.Gastroenterology. 2012; 143: 375-381
- Incidence and mortality of colorectal adenocarcinoma in persons with inflammatory bowel disease from 1998 to 2010.Gastroenterology. 2012; 143: 382-389
- Dysplasia in inflammatory bowel diseases.Dig Liver Dis. 2013; 45: 186-194
- Population-based epidemiology, malignancy risk, and outcome of primary sclerosing cholangitis.Hepatology. 2013; 58: 2045-2055
- Malignancy and mortality in pediatric-onset inflammatory bowel disease: a systematic review.Inflamm Bowel Dis. 2018; 24: 732-741
- Carcinoma of the colon and rectum.in: Bosman F.T. Carneiro F. Hruban R.H. Theise N.D. WHO classification of tumours of the digestive system. 4th ed. IARC Press, Lyon2010: 131-146
- Dysplasia in inflammatory bowel disease.Acta Gastroenterol Belg. 2017; 80: 299-308
- Colorectal cancer in inflammatory bowel disease.Clin Colon Rectal Surg. 2018; 31: 168-178
- Assessment of peri-polyp biopsy specimens of flat mucosa in patients with inflammatory bowel disease.Gastrointest Endosc. 2018; 87: 1304-1309
- Colorectal cancer in inflammatory bowel disease: review of the evidence.Tech Coloproctol. 2019; 23: 3-13
- Variability in the diagnosis of dysplasia in ulcerative colitis by dynamic telepathology.Oncol Rep. 2006; 16: 1123-1129
- Interobserver variability in the diagnosis of ulcerative colitis-associated dysplasia by telepathology.Mod Pathol. 2002; 15: 379-386
- Inter-observer and intra-observer variability in the diagnosis of dysplasia in patients with inflammatory bowel disease: correlation of pathological and endoscopic findings.Colorectal Dis. 2014; 16: 710-718
Article info
Publication history
Published online: December 26, 2019
Accepted:
November 8,
2019
Received:
September 28,
2019
Identification
Copyright
© 2019 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.