The importance of histopathological examination in the diagnosis and differential diagnosis of inflammatory bowel disease (IBD)

Abstract

Introduction. The inflammatory bowel disease is an idiopathic, chronic, disabling disease that appears from the interaction of the environmental and genetic factors. The ulcerative colitis (UC) and Crohn’s disease (CD) represent the two major types of inflammatory bowel disease. The correct diagnosis of IBD is crucial as it is a lifelong disorder and requires a multidisciplinary approach. Another major problem of the diagnosis is the presence of mimics. One of the most important aspects in diagnosis is the histopathological examination correlated with clinical, laboratory and endoscopic data. This study will highlight the importance and necessity of histopathological criteria for the diagnosis of IBD. Aim of study. Identification of histopathological criteria characteristic of the ulcerative colitis and Crohn’s disease used in diagnosis and differential diagnosis of IBD. Methods and materials. We have examined macroscopically and histologically some clinical cases suspicious of IBD from several institutions and have studied and revised the specialized literature and international guides from European Consensus on the Histopathology of the inflammatory bowel disease. Results. The need to collaborate with the clinician and the endoscopist has emerged after examining the biopsy material. It was due to the absence of an exact test that would facilitate the diagnosis, the presence of histological changes that could mimic this pathology as well as the existence of atypical forms of manifestation of IBD. Through the histopathological examination we can diagnose and classify IBD, identify the degree of inflammatory process activity, the distribution and the degree of anatomical extension, the presence or absence of dysplasia or malignancies as well as the response to treatment. There are 4 categories of IBD mimics: 1) caused by specific infection, 2) caused by iatrogenic factors, 3) those due to a specific localized inflammatory process and 4) rare causes. Conclusion. A correct diagnosis is the most valuable step towards healing in IBD. It requires a multidisciplinary correlation and, most importantly, endoscopic and histological approaches. Unfortunately, there are frequent difficulties in the diagnosis of inflammatory bowel disease, due to the absence of meetings and collective discussions between the teams of clinicians, endoscopists and pathologists and the lack of internal protocols adapted to the existing conditions.