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Natural History of Indeterminate Colitis

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Abstract

The term indeterminate colitis (IC) refers to a heterogeneous subset of patients with inflammatory bowel disease (IBD) that has features that makes a diagnosis of Crohn’s disease or ulcerative colitis uncertain. It is often defined as IBD that is primarily limited to the colon that has clinical features inconsistent with UC. Marked variability in the usage of this term among physicians has resulted in widespread differences in the prevalence of this condition and has limited our understanding of its natural history.

In this chapter, we explore the factors which lead to the diagnosis of indeterminate colitis, review the definitions of IC that have been used in the literature, address the role of modern noninvasive diagnostic tools in the determination of IC, describe the epidemiology of this condition relative to that of CD and UC, discuss the natural history of IC, and summarize the clinical report of the combined NASPGHAN/CCFA working group on the differentiation between ulcerative colitis and Crohn’s disease in children and young adults.

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References

  1. Bousvaros A, Antonioli DA, Colletti RB, et al. Differentiating ulcerative colitis from Crohn disease in children and young adults: report of a working group of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the Crohn’s and Colitis Foundation of America. J Pediatr Gastroenterol Nutr. 2007;44:653–74.

    Article  PubMed  Google Scholar 

  2. Glickman JN, Bousvaros A, Farraye FA, et al. Pediatric patients with untreated ulcerative colitis may present initially with unusual morphologic findings. Am J Surg Pathol. 2004;28:190–7.

    Article  PubMed  Google Scholar 

  3. Rajwal SR, Puntis JW, McClean P, et al. Endoscopic rectal sparing in children with untreated ulcerative colitis. J Pediatr Gastroenterol Nutr. 2004;38:66–9.

    Article  PubMed  Google Scholar 

  4. De Matos V, Russo PA, Cohen AB, Mamula P, Baldassano RN, Piccoli DA. Frequency and clinical correlations of granulomas in children with Crohn disease. J Pediatr Gastroenterol Nutr. 2008;46:392–8.

    Article  PubMed  Google Scholar 

  5. IBD Working Group of the European Society for Paediatric Gastroenterology. Inflammatory bowel disease in children and adolescents: recommendations for diagnosis—the Porto criteria. J Pediatr Gastroenterol Nutr. 2005;41:1–7.

    Article  Google Scholar 

  6. Odze RD. Pathology of indeterminate colitis. J Clin Gastroenterol. 2004;38:S36–40.

    Article  PubMed  Google Scholar 

  7. Price AB. Overlap in the spectrum of non-specific inflammatory bowel disease–’colitis indeterminate’. J Clin Pathol. 1978;31:567–77.

    Article  PubMed  CAS  Google Scholar 

  8. Moum B, Vatn MH, Ekbom A, et al. Incidence of inflammatory bowel disease in southeastern Norway: evaluation of methods after 1 year of registration. Southeastern Norway IBD Study Group of Gastroenterologists. Digestion. 1995;56(5):377–81.

    Article  PubMed  CAS  Google Scholar 

  9. Kugathasan S, Judd RH, Hoffmann RG, et al. Epidemiologic and clinical characteristics of children with newly diagnosed inflammatory bowel disease in Wisconsin: a statewide population-based study. J Pediatr. 2003;143(4):525–31.

    Article  PubMed  Google Scholar 

  10. Silverberg MS, Satsangi J, Ahmad T, et al. Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. Can J Gastroenterol. 2005;19(Suppl A):5–36.

    PubMed  Google Scholar 

  11. Geboes K, Colombel JF, Greenstein A, et al. Indeterminate colitis: a review of the concept–what’s in a name? Inflamm Bowel Dis. 2008;14:850–7.

    Article  PubMed  Google Scholar 

  12. Joossens S, Reinisch W, Vermeire S, et al. The value of serologic markers in indeterminate colitis: a prospective follow-up study. Gastroenterology. 2002;122:1242–7.

    Article  PubMed  Google Scholar 

  13. Khor B, Gardet A, Xavier RJ. Genetics and pathogenesis of inflammatory bowel disease. Nature. 2011;474:307–17.

    Article  PubMed  CAS  Google Scholar 

  14. Darbari A, Sena L, Argani P, Oliva-Hemker JM, Thompson R, Cuffari C. Gadolinium-enhanced magnetic resonance imaging: a useful radiological tool in diagnosing pediatric IBD. Inflamm Bowel Dis. 2004;10:67–72.

    Article  PubMed  Google Scholar 

  15. Lopes S, Figueiredo P, Portela F, et al. Capsule endoscopy in inflammatory bowel disease type unclassified and indeterminate colitis serologically negative. Inflamm Bowel Dis. 2010;16:1663–8.

    Article  PubMed  Google Scholar 

  16. Leighton JA, Legnani P, Seidman EG. Role of capsule endoscopy in inflammatory bowel disease: where we are and where we are going. Inflamm Bowel Dis. 2007;13:331–7.

    Article  PubMed  Google Scholar 

  17. Bardhan KD, Simmonds N, Royston C, Dhar A, Edwards CM. A United Kingdom inflammatory bowel disease database: making the effort worthwhile. J Crohns Colitis. 2010;4:405–12.

    Article  PubMed  CAS  Google Scholar 

  18. Karolewska-Bochenek K, Lazowska-Przeorek I, Albrecht P, et al. Epidemiology of inflammatory bowel disease among children in Poland. A prospective, population-based, 2-year study, 2002–2004. Digestion. 2009;79:121–9.

    Article  PubMed  Google Scholar 

  19. Heyman MB, Kirschner BS, Gold BD, et al. Children with early-onset inflammatory bowel disease (IBD): analysis of a pediatric IBD consortium registry. J Pediatr. 2005;146:35–40.

    Article  PubMed  Google Scholar 

  20. Hildebrand H, Finkel Y, Grahnquist L, Lindholm J, Ekbom A, Askling J. Changing pattern of paediatric inflammatory bowel disease in northern Stockholm 1990–2001. Gut. 2003;52:1432–4.

    Article  PubMed  CAS  Google Scholar 

  21. van der Zaag-Loonen HJ, Casparie M, Taminiau JA, Escher JC, Pereira RR, Derkx HH. The incidence of pediatric inflammatory bowel disease in the Netherlands: 1999–2001. J Pediatr Gastroenterol Nutr. 2004;38:302–7.

    Article  PubMed  Google Scholar 

  22. Carvalho RS, Abadom V, Dilworth HP, Thompson R, Oliva-Hemker M, Cuffari C. Indeterminate colitis: a significant subgroup of pediatric IBD. Inflamm Bowel Dis. 2006;12:258–62.

    Article  PubMed  Google Scholar 

  23. Malaty HM, Fan X, Opekun AR, Thibodeaux C, Ferry GD. Rising incidence of inflammatory bowel disease among children: a 12-year study. J Pediatr Gastroenterol Nutr. 2010;50:27–31.

    Article  PubMed  Google Scholar 

  24. Castro M, Papadatou B, Baldassare M, et al. Inflammatory bowel disease in children and adolescents in Italy: data from the pediatric national IBD register (1996–2003). Inflamm Bowel Dis. 2008;14:1246–52.

    Article  PubMed  CAS  Google Scholar 

  25. Prenzel F, Uhlig HH. Frequency of indeterminate colitis in children and adults with IBD - a metaanalysis. J Crohns Colitis. 2009;3:277–81.

    Article  PubMed  Google Scholar 

  26. Newby EA, Croft NM, Green M, et al. Natural history of paediatric inflammatory bowel diseases over a 5-year follow-up: a retrospective review of data from the register of paediatric inflammatory bowel diseases. J Pediatr Gastroenterol Nutr. 2008;46:539–45.

    Article  PubMed  Google Scholar 

  27. Stewenius J, Adnerhill I, Ekelund GR, et al. Risk of relapse in new cases of ulcerative colitis and indeterminate colitis. Dis Colon Rectum. 1996;39:1019–25.

    Article  PubMed  CAS  Google Scholar 

  28. Romberg-Camps MJ, Dagnelie PC, Kester AD, et al. Influence of phenotype at diagnosis and of other potential prognostic factors on the course of inflammatory bowel disease. Am J Gastroenterol. 2009;104:371–83.

    Article  PubMed  CAS  Google Scholar 

  29. Moum B, Ekbom A, Vatn MH, et al. Inflammatory bowel disease: re-evaluation of the diagnosis in a prospective population based study in south eastern Norway. Gut. 1997;40:328–32.

    PubMed  CAS  Google Scholar 

  30. Meucci G, Bortoli A, Riccioli FA, et al. Frequency and clinical evolution of indeterminate colitis: a retrospective multi-centre study in northern Italy. GSMII (Gruppo di Studio per le Malattie Infiammatorie Intestinali). Eur J Gastroenterol Hepatol. 1999;11:909–13.

    Article  PubMed  CAS  Google Scholar 

  31. Lindberg E, Lindquist B, Holmquist L, Hildebrand H. Inflammatory bowel disease in children and adolescents in Sweden, 1984–1995. J Pediatr Gastroenterol Nutr. 2000;30:259–64.

    Article  PubMed  CAS  Google Scholar 

  32. Mamula P, Telega GW, Markowitz JE, et al. Inflammatory bowel disease in children 5 years of age and younger. Am J Gastroenterol. 2002;97(8):2005–10.

    Article  PubMed  Google Scholar 

  33. Burakoff R. Indeterminate colitis: clinical spectrum of disease. J Clin Gastroenterol. 2004;38:S41–3.

    Article  PubMed  Google Scholar 

  34. Black A, Bhayani H, Ryder C, Pugh M, Gardner-Medwin J, Southwood T. Infliximab in the Treatment of Medically Refractory Indeterminate Colitis. Aliment Pharmacol Ther. 2003;18:741–8.

    Article  Google Scholar 

  35. Yu CS, Pemberton JH, Larson D. Ileal pouch-anal anastomosis in patients with indeterminate colitis: long-term results. Dis Colon Rectum. 2000;43:1487–96.

    Article  PubMed  CAS  Google Scholar 

  36. McIntyre PB, Pemberton JH, Wolff BG, Dozois RR, Beart Jr RW. Indeterminate colitis. Long-term outcome in patients after ileal pouch-anal anastomosis. Dis Colon Rectum. 1995;38:51–4.

    Article  PubMed  CAS  Google Scholar 

  37. Delaney CP, Remzi FH, Gramlich T, Dadvand B, Fazio VW. Equivalent function, quality of life and pouch survival rates after ileal pouch-anal anastomosis for indeterminate and ulcerative colitis. Ann Surg. 2002;236:43–8.

    Article  PubMed  Google Scholar 

  38. Murrell ZA, Melmed GY, Ippoliti A, et al. A prospective evaluation of the long-term outcome of ileal pouch-anal anastomosis in patients with inflammatory bowel disease-unclassified and indeterminate colitis. Dis Colon Rectum. 2009;52:872–8.

    Article  PubMed  Google Scholar 

  39. Arrossi AV, Kariv Y, Bronner MP, et al. Backwash ileitis does not affect pouch outcome in patients with ulcerative colitis with restorative proctocolectomy. Clin Gastroenterol Hepatol. 2011;9:981–8.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Pediatric Gastroenterology, University of North Carolina at Chapel Hill, 260 MacNider Building, CB #7220, 110 North Medical Drive, Chapel Hill, NC, 27599-7220, USA

    Mary K. Rogers Boruta MD & Michael D. Kappelman MD, MPH

  2. Division of Gastroenterology and Nutrition, Children’s Hospital Boston, and Department of Pediatrics, Center for Inflammatory Bowel Disease Treatment and Research, Harvard Medical School, Boston, MA, 02115, USA

    Richard J. Grand MD

Authors
  1. Mary K. Rogers Boruta MD
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  2. Richard J. Grand MD
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  3. Michael D. Kappelman MD, MPH
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Corresponding author

Correspondence to Mary K. Rogers Boruta MD .

Editor information

Editors and Affiliations

  1. Perelman School of Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania, 34th St. & Civic Ctr. Blvd., Philadelphia, 19104, Pennsylvania, USA

    Petar Mamula

  2. School of Medicine--Greenville, Pediatric Gastroenterology & Nutrition, University of South Carolina, 200 Patewood Drive, Suite A-140, Greenville, 29615, South Carolina, USA

    Jonathan E. Markowitz

  3. Perelman School of Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, 34th St. & Civic Ctr. Blvd., Philadelphia, 19104, Pennsylvania, USA

    Robert N. Baldassano

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Boruta, M.K.R., Grand, R.J., Kappelman, M.D. (2013). Natural History of Indeterminate Colitis. In: Mamula, P., Markowitz, J., Baldassano, R. (eds) Pediatric Inflammatory Bowel Disease. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-5061-0_9

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  • DOI: https://doi.org/10.1007/978-1-4614-5061-0_9

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  • Online ISBN: 978-1-4614-5061-0

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