Skip to main content

Pathology of Inflammatory Bowel Disease

  • Chapter
  • First Online:

Abstract

The diagnosis of inflammatory bowel disease (IBD) is made through collaboration between gastroenterologist and pathologist. Geared towards the clinician and pathologist in training, the following chapter focuses specifically on the microscopic and macroscopic features that define both Crohn’s disease (CD) and ulcerative colitis (UC). In addition to presenting the classic histopathologic features of IBD, pertinent clinical and histologic mimics within the differential diagnosis are discussed in detail. Finally, as IBD is a chronic disease, it is important to extend the discussion beyond differential diagnostic considerations to issues concerning disease progression and treatment related complications. Emphasis is placed on communication within the team of pathologists and clinicians to facilitate optimal patient care.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Kumar V, Abbas AK, Fausto N, Aster J. Robbins and Cotran pathologic basis of disease. 8th ed. Philadelphia, PA: Elsevier Saunders; 2009.

    Google Scholar 

  2. Paterson JC, Watson SH. Paneth cell metaplasia in ulcerative colitis. Am J Pathol. 1961;38:243–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  3. Kleer CG, Appelman HD. Ulcerative colitis: patterns of involvement in colorectal biopsies and changes with time. Am J Surg Pathol. 1998;22(8):983–9.

    Article  CAS  PubMed  Google Scholar 

  4. Binder V. A comparison between clinical state, macroscopic and microscopic appearances of rectal mucosa, and cytologic picture of mucosal exudate in ulcerative colitis. Scand J Gastroenterol. 1970;5(7):627–32.

    CAS  PubMed  Google Scholar 

  5. Gomes P, du Boulay C, Smith CL, Holdstock G. Relationship between disease activity indices and colonoscopic findings in patients with colonic inflammatory bowel disease. Gut. 1986;27(1):92–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Geert D’haens, William J. Sandborn, Brian G. Feagan, Karel Geboes, Stephen B. Hanauer, E. Jan Irvine et al. A review of activity indices and efficacy end points for clinical trials of medical therapy in adults with ulcerative colitis. Gastroenterology. 2007;132(2):763–86.

    Google Scholar 

  7. Joo M, Odze RD. Rectal sparing and skip lesions in ulcerative colitis: a comparative study of endoscopic and histologic findings in patients who underwent proctocolectomy. Am J Surg Pathol. 2010;34(5):689–96.

    PubMed  Google Scholar 

  8. Velayos FS, Loftus Jr EV, Jess T, et al. Predictive and protective factors associated with colorectal cancer in ulcerative colitis: a case-control study. Gastroenterology. 2006;130(7):1941–9.

    Article  PubMed  Google Scholar 

  9. Haskell H, Andrews Jr CW, Reddy SI, et al. Pathologic features and clinical significance of “backwash” ileitis in ulcerative colitis. Am J Surg Pathol. 2005;29(11):1472–81.

    Article  PubMed  Google Scholar 

  10. Okita Y, Miki C, Araki T, et al. Ulcerative colitis with severe backwash ileitis successfully treated by staged operation without sacrificing any involved ileum. J Pediatr Surg. 2009;44(1):e37–9.

    Article  PubMed  Google Scholar 

  11. D'Haens G, Geboes K, Peeters M, Baert F, Ectors N, Rutgeerts P. Patchy cecal inflammation associated with distal ulcerative colitis: a prospective endoscopic study. Am J Gastroenterol. 1997;92(8):1275–9.

    PubMed  Google Scholar 

  12. Ladefoged K, Munck LK, Jorgensen F, Engel P. Skip inflammation of the appendiceal orifice: a prospective endoscopic study. Scand J Gastroenterol. 2005;40(10):1192–6.

    Article  PubMed  Google Scholar 

  13. Yang SK, Jung HY, Kang GH, et al. Appendiceal orifice inflammation as a skip lesion in ulcerative colitis: an analysis in relation to medical therapy and disease extent. Gastrointest Endosc. 1999;49(6):743–7.

    Article  CAS  PubMed  Google Scholar 

  14. Washington K, Greenson JK, Montgomery E, et al. Histopathology of ulcerative colitis in initial rectal biopsy in children. Am J Surg Pathol. 2002;26(11):1441–9.

    Article  PubMed  Google Scholar 

  15. Markowitz J, Kahn E, Grancher K, Hyams J, Treem W, Daum F. Atypical rectosigmoid histology in children with newly diagnosed ulcerative colitis. Am J Gastroenterol. 1993;88(12):2034–7.

    CAS  PubMed  Google Scholar 

  16. Baron JH. Inflammatory bowel disease up to 1932. Mt Sinai J Med. 2000;67(3):174–89.

    CAS  PubMed  Google Scholar 

  17. Crohn BB, Ginzburg L, Oppenheimer GD. Regional ileitis; a pathologic and clinical entity. JAMA. 1932;99:1323–8.

    Article  Google Scholar 

  18. Bernstein CN, Blanchard JF, Kliewer E, Wajda A. Cancer risk in patients with inflammatory bowel disease: a population-based study. Cancer. 2001;91(4):854–62.

    Article  CAS  PubMed  Google Scholar 

  19. Rubin DT, Turner JR. Surveillance of dysplasia in inflammatory bowel disease: the gastroenterologist-pathologist partnership. Clin Gastroenterol Hepatol. 2006;4(11):1309–13.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Odze RD. Adenomas and adenoma-like DALMs in chronic ulcerative colitis: a clinical, pathological, and molecular review. Am J Gastroenterol. 1999;94(7):1746–50.

    Article  CAS  PubMed  Google Scholar 

  21. Brentnall TA, Haggitt RC, Rabinovitch PS, et al. Risk and natural history of colonic neoplasia in patients with primary sclerosing cholangitis and ulcerative colitis. Gastroenterology. 1996;110(2):331–8.

    Article  CAS  PubMed  Google Scholar 

  22. Veloso FT, Carvalho J, Magro F. Immune-related systemic manifestations of inflammatory bowel disease. A prospective study of 792 patients. J Clin Gastroenterol. 1996;23(1):29–34.

    Article  CAS  PubMed  Google Scholar 

  23. Mir-Madjlessi SH, Taylor JS, Farmer RG. Clinical course and evolution of erythema nodosum and pyoderma gangrenosum in chronic ulcerative colitis: a study of 42 patients. Am J Gastroenterol. 1985;80(8):615–20.

    CAS  PubMed  Google Scholar 

  24. Tavarela VF. Review article: skin complications associated with inflammatory bowel disease. Aliment Pharmacol Ther. 2004;20 Suppl 4:50–3.

    Article  Google Scholar 

  25. Fenoglio-Preiser CM. Gastrointestinal pathology: an atlas and text. 3rd ed. Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins; 2008.

    Google Scholar 

  26. Ayata G, Ithamukkala S, Sapp H, et al. Prevalence and significance of inflammatory bowel disease-like morphologic features in collagenous and lymphocytic colitis. Am J Surg Pathol. 2002;26(11):1414–23.

    Article  PubMed  Google Scholar 

  27. Oya M, Yao T, Tsuneyoshi M. Chronic irradiation enteritis: its correlation with the elapsed time interval and morphological changes. Hum Pathol. 1996;27(8):774–81.

    Article  CAS  PubMed  Google Scholar 

  28. Gandhi SK, Hanson MM, Vernava AM, Kaminski DL, Longo WE. Ischemic colitis. Dis Colon Rectum. 1996;39(1):88–100.

    Article  CAS  PubMed  Google Scholar 

  29. Makapugay LM, Dean PJ. Diverticular disease-associated chronic colitis. Am J Surg Pathol. 1996;20(1):94–102.

    Article  CAS  PubMed  Google Scholar 

  30. Gledhill A, Dixon MF. Crohn’s-like reaction in diverticular disease. Gut. 1998;42(3):392–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Goldstein NS, Leon-Armin C, Mani A. Crohn’s colitis-like changes in sigmoid diverticulitis specimens is usually an idiosyncratic inflammatory response to the diverticulosis rather than Crohn’s colitis. Am J Surg Pathol. 2000;24(5):668–75.

    Article  CAS  PubMed  Google Scholar 

  32. Lehner T. Pathology of recurrent oral ulceration and oral ulceration in Behcet’s syndrome: light, electron and fluorescence microscopy. J Pathol. 1969;97(3):481–94.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Christopher R. Weber M.D., Ph.D. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

Joseph, N.E., Weber, C.R. (2017). Pathology of Inflammatory Bowel Disease. In: Baumgart, D. (eds) Crohn's Disease and Ulcerative Colitis. Springer, Cham. https://doi.org/10.1007/978-3-319-33703-6_22

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-33703-6_22

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-33701-2

  • Online ISBN: 978-3-319-33703-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics