Inflammatory Bowel Disease or Not: Importance of Histological Evaluation of Colonic Biopsies, Six Months' Experience at Chughtai Institute of Pathology
DOI:
https://doi.org/10.54112/bcsrj.v6i6.1896Keywords:
IBD, Crohn's disease, Granulomas, Colonoscopy, Clinical presentationAbstract
Inflammatory bowel disease (IBD), encompassing Crohn's disease (CD) and ulcerative colitis (UC), is a chronic condition characterized by inflammation of the gastrointestinal tract. Objective: The objective of this study was to evaluate the role of histopathological features, such as crypt distortion, mucin depletion, cryptitis, crypt abscesses, and granuloma, in distinguishing IBD from other gastrointestinal disorders and assessing disease activity. Methods: This study is a cross-sectional study conducted at Chughtai Institute of Pathology from 01-OCT-2023 to 10-Mar-2024. A total of 370 patients were enrolled in the study. The sample size was calculated using the WHO sample size calculator. Data collection was conducted through a structured protocol, including patient demographics (age, gender, clinical symptoms), endoscopic findings, and histopathological results from colonic biopsies. Colonoscopy was performed under standard clinical procedures, and tissue samples were taken from the colon during the procedure. Results: Granulomas were present in 25% of Crohn's disease cases, while cryptitis and mucosal ulceration were observed in 40% and 66% of ulcerative colitis cases, respectively. Crypt abscesses were more common in ulcerative colitis (55%) than in Crohn's disease (12.5%). Associated infections, including C. difficile, were noted in 3.5% of cases, emphasizing the need for a differential diagnosis. Age distribution varied from 4 to 102 years, with a mean age of 35.9 years. Conclusion: Histological examination remains an essential tool in the diagnosis and differentiation of IBD from other colonic disorders. Granulomas, cryptitis, and crypt abscesses are key features that aid in distinguishing Crohn's disease from ulcerative colitis. Histopathology also plays a critical role in assessing disease activity and guiding therapeutic decisions.
Downloads
References
Feakins R, Borralho Nunes P, Driessen A, Gordon IO, Zidar N, Baldin P, et al. Definitions of histological abnormalities in inflammatory bowel disease: an ECCO position paper. J Crohns Colitis. 2024;18(2):175-191. https://doi.org/10.1093/ecco-jcc/jjad142.
Radford SJ, McGing J, Czuber-Dochan W, Moran G. Systematic review: the impact of inflammatory bowel disease-related fatigue on health-related quality of life. Frontline Gastroenterol. 2021;12(1):11-21. https://doi.org/10.1136/flgastro-2019-101355
Hammer T, Langholz E. The epidemiology of inflammatory bowel disease: balance between East and West? A narrative review. Dig Med Res. 2020;3:48. https://doi.org/10.21037/dmr-20-149.
Piovani D, Danese S, Peyrin-Biroulet L, Nikolopoulos GK, Lytras T, Bonovas S. Environmental risk factors for inflammatory bowel diseases: an umbrella review of meta-analyses. Gastroenterology. 2019;157(3):647-659.e4. https://doi.org/10.1053/j.gastro.2019.04.016
Feakins RM; British Society of Gastroenterology. Inflammatory bowel disease biopsies: updated British Society of Gastroenterology reporting guidelines. J Clin Pathol. 2013;66(12):1005-26. https://doi.org/10.1136/jclinpath-2013-201885
Chateau T, Feakins R, Marchal-Bressenot A, Magro F, Danese S, Peyrin-Biroulet L. Histological remission in ulcerative colitis: under the microscope is the cure. Am J Gastroenterol. 2020;115(2):179-189. https://doi.org/10.14309/ajg.0000000000000437
Morgenstern S, Brook E, Rinawi F, Shamir R, Assa A. Tissue and peripheral eosinophilia as predictors for disease outcome in children with ulcerative colitis. Dig Liver Dis. 2017;49(2):170-174. https://doi.org/10.1016/j.dld.2016.11.007
Magro F, Doherty G, Peyrin-Biroulet L, Svrcek M, Borralho P, Walsh A, et al. ECCO position paper: harmonization of the approach to ulcerative colitis histopathology. J Crohns Colitis. 2020;14(11):1503-1511. https://doi.org/10.1093/ecco-jcc/jjaa110
Bressenot A, Salleron J, Bastien C, Danese S, Boulagnon-Rombi C, Peyrin-Biroulet L. Comparing histological activity indexes in UC. Gut. 2015;64(9):1412-1418. https://doi.org/10.1136/gutjnl-2014-307477
Mosli MH, Feagan BG, Zou G, Sandborn WJ, D’Haens G, Khanna R, et al. Development and validation of a histological index for UC. Gut. 2017;66(1):50-58. https://doi.org/10.1136/gutjnl-2015-310393
Marchal-Bressenot A, Salleron J, Boulagnon-Rombi C, et al. Development and validation of the Nancy histological index for UC. Gut. 2017;66(1):43–49. https://doi.org/10.1136/gutjnl-2015-310187
Mosli MH, Parker CE, Nelson SA, et al. Histologic scoring indices for evaluation of disease activity in ulcerative colitis. Cochrane Database Syst Rev. 2017;5(5):CD011256. https://doi.org/10.1002/14651858.CD011256.pub2 PubMed
Magro F, Doherty G, Peyrin-Biroulet L, et al. ECCO position paper: harmonization of the approach to ulcerative colitis histopathology. J Crohns Colitis. 2020;14(11):1503–1511. https://doi.org/10.1093/ecco-jcc/jjaa110
Lang-Schwarz C, Agaimy A, Atreya R, et al. Maximizing the diagnostic information from biopsies in chronic inflammatory bowel diseases: recommendations from the Erlangen International Consensus Conference and presentation of the IBD-DCA score. Virchows Arch. 2021;478(3):581–594. https://doi.org/10.1007/s00428-020-02982-7
Ha CWY, Martin A, Sepich-Poore GD, et al. Translocation of viable gut microbiota to mesenteric adipose drives formation of creeping fat in humans. Cell. 2020;183(3):666–683.e17. https://doi.org/10.1016/j.cell.2020.09.009
Hong SW, Yoon H, Shin CM, et al. Clinical significance of granulomas in Crohn’s disease: a systematic review and meta-analysis. J Gastroenterol Hepatol. 2020;35(3):364–373. https://doi.org/10.1111/jgh.14849
Lin WC, Chang CW, Chen MJ, et al. Challenges in the diagnosis of ulcerative colitis with concomitant bacterial infections and chronic infectious colitis. PLoS One. 2017;12(12):e0189377. https://doi.org/10.1371/journal.pone.0189377
Park S, Abdi T, Gentry M, Laine L. Histological disease activity as a predictor of clinical relapse among patients with ulcerative colitis: systematic review and meta-analysis. Am J Gastroenterol. 2016;111(12):1692–1701. https://doi.org/10.1038/ajg.2016.418
Pai RK, Hartman DJ, Rivers CR, et al. Complete resolution of mucosal neutrophils associates with improved long-term clinical outcomes of patients with ulcerative colitis. Clin Gastroenterol Hepatol. 2020;18(11):2510–2517.e5. https://doi.org/10.1016/j.cgh.2019.12.011
Ferman M, Lim AH, Hossain M, et al. Multidisciplinary team meetings appear to be effective in inflammatory bowel disease management: an audit of process and outcomes. Intern Med J. 2018;48(9):1102–1108. https://doi.org/10.1111/imj.13965 Ovid
Akhtar TS, Ashraf B, Zahid K, Abbas S, Sana A, Khan AR, et al. Evaluation of factors contributing to diagnosis of Crohn’s disease in the face of increasing trend in Pakistan. Crohns Colitis 360. 2024;6(1):otae015. https://doi.org/10.1093/crocol/otae015
Villanacci V, Del Sordo R, Parigi TL, Leoncini G, Bassotti G. Inflammatory bowel diseases: does one histological score fit all? Diagnostics (Basel). 2023;13(12):2112. https://doi.org/10.3390/diagnostics13122112
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Farhat Batool, Saira Rathore, Fizza Jahangir, Akhtar Sohail Chughtai, Samina Zaman

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.