Practical Inflammatory Bowel Disease Pathology in Patient Management

The correct interpretation of biopsy material in cases of IBD requires detailed knowledge of the clinical information andendoscopy findings, along with carefully sampled normal and abnormal regions of the affected bowel. The biopsy appearances of CIBD change with time and treatment. Biopsies taken within 6 weeks of onset may closelymimic infective colitis whereas post-treatment material from ulcerative colitis patients may closely resemble Crohn'sdisease. While tempting to biopsy, focal lesions such as polyps and ulcers can only be interpreted properly and in context whenbiopsies from surrounding normal and abnormal mucosa are also submitted. "Indeterminate colitis" must only be used in the context of resection specimens when careful macroscopic andmicroscopic examination fails to distinguish definitively between ulcerative colitis and Crohn's disease. The term "IBDunclassified" is used when a diagnosis of CIBD can be made on biopsy material but a confident diagnosis of ulcerativecolitis or Crohn's cannot. In cases where the patient's clinical course and response to treatment remains inconsistent with an original CIBDdiagnosis, repeat biopsies can be very useful. Review of all previously submitted material, in conjunction with review ofthe radiologic and endoscopic findings, may also be necessary. © 2010 Blackwell Publishing Ltd.