• Paula Borralho NunesEmail author


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.


Inflammatory bowel disease Ulcerative colitis Crohn’s disease Histopathology Diagnosis 



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.


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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Instituto de Anatomia PatológicaFaculdade de Medicina da Universidade de LisboaLisbonPortugal
  2. 2.Hospital Cuf DescobertasLisbonPortugal

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