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Pathology of indeterminate colitis.

Robert D Odze1

  • 1GI Pathology Service, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. rodze@partners.org

Journal of Clinical Gastroenterology
|April 30, 2004
PubMed
Summary

Indeterminate colitis (IC) is a preliminary diagnosis in inflammatory bowel disease (IBD) when ulcerative colitis (UC) or Crohn

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Area of Science:

  • Gastroenterology and Hepatology
  • Pathology
  • Colorectal Surgery

Background:

  • Indeterminate colitis (IC) is a provisional pathological diagnosis for inflammatory bowel disease (IBD) when definitive classification as ulcerative colitis (UC) or Crohn's disease (CD) is not possible.
  • Fulminant UC can present with features overlapping CD, including superficial ulceration and transmural inflammation, complicating diagnosis.
  • Diagnostic challenges include distinguishing backwash ileitis in UC from ileal CD and recognizing UC variants that mimic CD.

Purpose of the Study:

  • To clarify the nature of indeterminate colitis (IC) and its relationship to ulcerative colitis (UC) and Crohn's disease (CD).
  • To evaluate the diagnostic criteria and natural history of IC.
  • To assess the risk of pouch complications in patients with IC undergoing ileal pouch-anal anastomosis.

Main Methods:

  • Review of pathological features in cases diagnosed as indeterminate colitis (IC).
  • Analysis of clinical, endoscopic, radiologic, and pathological data for accurate IBD classification.
  • Comparison of long-term outcomes and pouch complication rates between IC, UC, and CD patients.

Main Results:

  • Most cases initially diagnosed as IC represent ulcerative colitis (UC) upon long-term follow-up.
  • Diagnostic overlap between UC and CD is common, necessitating comprehensive data review.
  • Indeterminate colitis (IC) patients exhibit pouch complication rates similar to UC patients, suggesting a shared underlying pathology.

Conclusions:

  • Indeterminate colitis (IC) is frequently a manifestation of ulcerative colitis (UC), particularly fulminant UC.
  • A definitive diagnosis of IC should be deferred until all clinical, endoscopic, radiologic, and pathological data are integrated.
  • Patients with IC likely have UC and can generally undergo ileal pouch-anal anastomosis with a good prognosis.

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