Chronic Colitis in Biopsy Samples: Is It Inflammatory Bowel Disease or Something Else?

Area of Science:

• Gastroenterology
• Pathology
• Histology

Background:

• Chronic colitis is histologically defined by chronic inflammation, primarily plasmacytosis, in the lamina propria.
• Accurate histological diagnosis of chronic colitis in biopsies presents challenges for pathologists.
• Distinguishing between various forms of chronic colitis is crucial for appropriate patient management.

Purpose of the Study:

• To discuss specific histologic features of inflammatory bowel diseases (IBD) in colon biopsies.
• To provide guidance on differentiating IBD (ulcerative colitis, Crohn colitis, indeterminate colitis) from other chronic colitides.
• To review normal colon biopsy histology for comparison.

Main Methods:

• Histological examination of colon biopsies.
• Comparative analysis of features across different colitis types.
• Literature review and expert consensus on diagnostic criteria.

Main Results:

• Detailed description of characteristic histological findings in ulcerative colitis, Crohn colitis, and indeterminate colitis.
• Identification of key features to differentiate IBD from lymphocytic colitis, collagenous colitis, diverticular disease-associated colitis, diversion colitis, and drug-induced colitis.
• Summary of normal colon biopsy histology.

Conclusions:

• Histologic assessment of colon biopsies is essential for diagnosing chronic colitis.
• Recognizing specific features aids in differentiating IBD from other chronic inflammatory conditions of the colon.
• This review provides a practical guide for pathologists managing patients with chronic colitis.