Abstract
The diagnosis of IBD requires a multidisciplinary approach involving a team of specialists that includes gastroenterologists, nurses, radiologists and pathologists.
The histologic examination of endoscopic biopsies or resection specimens is a crucial element in the diagnostic workup of a patient with suspected IBD and assists in making a final diagnosis, differentiating between UC and CD and other forms of colitis.
An adequate number of biopsies and a careful handling of the tissue are essential for an accurate diagnosis.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Ayre K, Warren BF, Jeffery K, Travis SPL (2009) The role of CMV in steroid-resistant ulcerative colitis: a systematic review. J Crohns Colitis 3:141–148
Bossuyt P, Van Assche G, Rutgeerts P, Vermeire S (2009) Increasing incidence of Clostridium difficile-associated diarrhea in inflammatory bowel disease. J Crohns Colitis 3:4–7
Buisine MP, Desreumaux P, Leteurtre E et al (2001) Mucin gene expression in intestinal epithelial cells in Crohn’s disease. Gut 49:544–551
Dejaco C, Oesterreicher C, Angelberger S et al (2003) Diagnosing colitis: a prospective study on essential parameters for reaching a diagnosis. Endoscopy 35:1004–1008
Geboes K, Desreumaux P, Jouret A et al (1999) Histopathologic diagnosis of the activity of chronic inflammatory bowel disease. Evaluation of the effect of drug treatment. Use of histological scores. Gastroenterol Clin Biol 23:1062–1073
Gerrits MM, Chen M, Theeuwes M et al (2011) Biomarker-based prediction of inflammatory bowel disease-related colorectal cancer: a case-control study. Cell Oncol 34:107–117
Itzkowitz SH (1997) Inflammatory bowel disease and cancer. Gastroenterol Clin N Am 26:129–139
Jenkins D, Balsitis M, Gallivan S, Dixon MF, Gilmour HM, Shepherd NA, Theodossi A, Williams GT (1997) Guidelines for the initial biopsy diagnosis of suspected chronic idiopathic inflammatory bowel disease. The British Society of Gastroenterology Initiative. J Clin Pathol 50(2):93–105
Kent TH, Ammon RK, Denbeste L (1970) Differentiation of ulcerative colitis and regional enteritis of colon. Arch Pathol 89:20–29
Kuwabara A, Okamoto H, Suda T, Ajioka Y, Hatakeyama K (2007) Clinicopathologic characteristics of clinically relevant cytomegalovirus infection in inflammatory bowel disease. J Gastroenterol 42:823–829
Lee KS, Medline A, Shockey S (1979) Indeterminate colitis in the spectrum of inflammatory bowel-disease. Arch Pathol Lab Med 103:173–176
Levine A, Koletzko S, Turner D, Escher JC, Cucchiara S, de Ridder L, Kolho KL, Veres G, Russell RK, Paerregaard A, Buderus S, Greer ML, Dias JA, Veereman-Wauters G, Lionetti P, Sladek M, Martin de Carpi J, Staiano A, Ruemmele FM, Wilson DC, European Society of Pediatric Gastroenterology, Hepatology, and Nutrition (2014) ESPGHAN revised Porto criteria for the diagnosis of inflammatory bowel disease in children and adolescents. J Pediatr Gastroenterol Nutr 58:795–806
Magro F, Langner C, Driessen A, Ensari A, Geboes K, Mantzaris GJ, Villanacci V, Becheanu G, Borralho Nunes P, Cathomas G, Fries W, Jouret-Mourin A, Mescoli C, de Petris G, Rubio CA, Shepherd NA, Vieth M, Eliakim R, European Society of Pathology (ESP), European Crohn’s and Colitis Organisation (ECCO) (2013) European consensus on the histopathology of inflammatory bowel disease. J Crohns Colitis 7(10):827–851
Mahadeva U, Martin JP, Patel NK, Price AB (2002) Granulomatous ulcerative colitis: a re-appraisal of the mucosal granuloma in the distinction of Crohn’s disease from ulcerative colitis. Histopathology 41:50–55
Marx A, Wandrey T, Simon P, Wewer A, Grob T, Reichelt U, Minner S, Simon R, Spehlmann M, Tigges W, Soehendra N, Seitz U, Seewald S, Izbicki JR, Yekebas E, Kaifi JT, Mirlacher M, Terracciano L, Fleischmann A, Raedler A, Sauter G (2009) Combined alpha-methylacyl coenzyme A racemase/p53 analysis to identify dysplasia in inflammatory bowel disease. Hum Pathol 40:166–173
Muto T, Kamiya J, Sawada T, Konishi F, Sugihara K, Kubota Y, Adachi M, Agawa S, Saito Y, Morioka Y (1985) Small “flat adenoma” of the large bowel with special reference to its clinicopathologic features. Dis Colon Rectum 28:847–851
Odze R, Antonioli D, Peppercorn M, Goldman H (1993) Effect of topical 5-aminosalicylic acid (5-ASA) therapy on rectal mucosal biopsy morphology in chronic ulcerative colitis. Am J Surg Pathol 17:869–875
Palascak-Juif V, Bouvier AM, Cosnes J, Flourié B, Bouché O, Cadiot G, Lémann M, Bonaz B, Denet C, Marteau P, Gambiez L, Beaugerie L, Faivre J, Carbonnel F (2005) Small bowel adenocarcinoma in patients with Crohn’s disease compared with small bowel adenocarcinoma de novo. Inflamm Bowel Dis. 11(9):828–832
Price AB (1978) Overlap in spectrum of nonspecific inflammatory bowel disease—Colitis indeterminate. J Clin Pathol 31:567–577
Riddell RH, Goldman H, Ransohoff DF et al (1983) Dysplasia in inflammatory bowel disease: standardized classification with provisional clinical applications. Hum Pathol 14:931–968
Rodemann JF, Dubberke ER, Reske KA, Seo D, Stone CD (2007) Incidence of Clostridium difficile infection in inflammatory bowel disease. Clin Gastroenterol Hepatol 5(3):339–344
Sanders DS (1998) The differential diagnosis of Crohn’s disease and ulcerative colitis. Baillieres Clin Gastroenterol 12:19–33
van Schaik FD, Oldenburg B, Offerhaus GJ et al (2012) Role of immunohistochemical markers in predicting progression of dysplasia to advanced neoplasia in patients with ulcerative colitis. Inflamm Bowel Dis 18:480–488
Seldenrijk CA, Morson BC, Meuwissen SGM et al (1991) Histopathological evaluation of colonic mucosal biopsy specimens in chronic inflammatory bowel disease: diagnostic implications. Gut 32:1514–1520
Surawicz CM, Haggitt RC, Husseman M, McFarland LV (1994) Mucosal biopsy diagnosis of colitis: acute self-limited colitis and idiopathic inflammatory bowel disease. Gastroenterology 107:755–763
Washington K, Greenson JK, Montgomery E et al (2002) Histopathology of ulcerative colitis in initial rectal biopsy in children. Am J Surg Pathol 26:1441–1449
Summary
The correct diagnosis of IBD requires a multidisciplinary approach where histology plays an essential part. However, histology has some limitations that should be well known. Adequate sampling and a careful handling and fixation of the tissue are critical, and optimum quality has to be guaranteed by quick immersion in fixative.
-
In UC the mucosa shows diffuse and continuous destructive chronic inflammation (including lymphocytes, plasma cells, eosinophils and neutrophils) with crypt distortion, which involves the rectum and spreads proximally. Cryptitis and crypt abscesses are characteristic of active disease, and basal plasmacytosis is the earliest diagnostic feature, helping in the differentiation from acute colitis.
-
CD shows a discontinuous pattern of inflammation that may affect any segment of the digestive tract with focal (discontinuous) chronic inflammation, focal architectural irregularity and granulomas (not related to crypt injury). The lesions are not limited to the mucosa as in UC and may affect the entire thickness of the gut wall.
-
Despite detailed histologic criteria used to differentiate Crohn’s colitis from ulcerative colitis in colonoscopic biopsies, no single pathognomonic lesion has been identified, and accurate discrimination between the two diseases is not always possible. The term inflammatory bowel disease unclassified (IBDU) should be used in these situations.
-
Infections have an important role, triggering the onset of IBD, triggering flares of disease and complicating the clinical picture. Histology may be very useful in the diagnosis of CMV infection but not C. difficile.
-
Histology has a very important role in the detection of dysplasia and IBD-associated carcinoma. Criteria for diagnosing dysplasia are well defined, and immunohistochemistry may be useful in difficult cases, although confirmation of dysplasia by an independent expert GI pathologist is recommended.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Nunes, P.B. (2019). Histopathology. In: Sturm, A., White, L. (eds) Inflammatory Bowel Disease Nursing Manual. Springer, Cham. https://doi.org/10.1007/978-3-319-75022-4_8
Download citation
DOI: https://doi.org/10.1007/978-3-319-75022-4_8
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-75021-7
Online ISBN: 978-3-319-75022-4
eBook Packages: MedicineMedicine (R0)