Bioptic microbiology in the differential diagnosis of enterocolitis

Parameters in the differential diagnosis of enterocolitis have been poorly evident for many years. Development and profitable employment of endoscopic instruments were the first step towards advancing the diagnostic facilities in inflammatory bowel disease. The microbiologic examination of mucosal biopsies creates a new diagnostic dimension, and it distinctly seems to increase the diagnostic sensitivity for pathogens. Within fifteen months 152 patients admitted to the gastroenterologic unit with acute, or symptoms of exacerbated, bowel disease were examined for the aetiologic agents. Compared with former reports, idiopathic inflammatory bowel disease (IIBD) such as Crohn's disease (32.2%) and ulcerative colitis (18.4%) were decreased. Infectious colitis (22.3%), mostly Campylobacter or Yersinia infections, was, sometimes exclusively, diagnosed by bioptic microbiology, non-classifiable forms of colitis (21.7%), and rare forms (5.4%) were diagnosed more often. It proved to be important that IIBD was frequently superinfected by Campylobacter, Yersinia and Chlamydia, and the differential diagnosis was complicated, since these microorganisms can mimic IIBD. The results suggest that coloileoscopy combined with bioptic microbiologic investigation additional to faecal samples should include a search for Campylobacter and Yersinia. It appears indispensable that the final diagnosis "Crohn's disease" or "ulcerative colitis" should be confirmed by sequential coloileoscopy and microbiologic examination.