The Morphologic Profile of Inflammatory Bowel Disease and the Diagnostic Problem of Crohn’s Disease versus TB Colitis– A Case Series

Abstract

The aim of this study is to describe the morphologic profile of the biopsy and resection specimen that were diagnosed with Crohn’s disease and ulcerative colitis in the University of the East Ramon Magsaysay Memorial Medical Center (UERMMMC) from 2008-2016. Features that classify the specimen as Inflammatory Bowel Disease – Indeterminate Type are also presented. Considerations for the definitive IBD classification after an initial indeterminate diagnosis by morphology are also briefly discussed. Biopsy and resection specimen that were diagnosed with Crohn’s disease, cannot exclude TB Colitis, are also presented; and the subsequent steps for a definitive classification are also discussed. All the patients included underwent an endoscopic biopsy, and are categorized by histopathologic diagnoses, age, sex, and GIT segment involved in the endoscopic procedure. Patients that underwent subsequent resection due to the disease condition are also identified.

Comparison of the histologic findings observed in the patients, with the microscopic basis for the diagnosis recommended by the European consensus on the histopathology of inflammatory bowel disease (2013), and with the histologic features described by Patil et al. (2015) for the inflammatory disorders of the large intestine, is done. The histologic features described by Lamps (2015) for the gastrointestinal TB is used in the evaluation of the findings in the patients diagnosed with Crohn’s disease, cannot exclude TB Colitis.

There are 5 Crohn’s disease patients, accounting for 0.8% of all patients with lower GIT inflammatory conditions, and 10 ulcerative colitis patients, accounting for 1.6% of all patients with lower GIT inflammatory conditions. Seven patients, which comprise 1.1% of all patients with lower GIT inflammatory conditions, have the diagnosis of indeterminate colitis. The histologic features of 6 out of 7 patients that had the initial diagnosis of indeterminate colitis presented with morphologic features that favored an ulcerative colitis, but with Crohn’s disease features. In comparison, one patient who had an initial diagnosis of indeterminate colitis presented with morphologic features that favored Crohn’s disease but with ulcerative colitis features. In these patients, correlation with chronology of symptoms and associated ancillary procedures that can classify the patients as CD or UC are recommended to the gastroenterologist attending such patients so that a more definitive classification can be done.

Four patients, accounting for 0.6% of all lower GIT inflammatory conditions, were initially diagnosed as Crohn’s disease, cannot exclude TB Colitis. This is in contrast with 34 patients who were diagnosed with diagnosed with Chronic Granulomatous Inflammation, Tuberculosis which accounted for 5.7% of all patients that were diagnosed with inflammatory conditions of the lower GIT. The remaining 536 patients were composed of acute self-limited/infectious colitis, ischemic colitis, eosinophilic colitis, inflammatory polyp, and nonspecific inflammation.

With the trend of increasing incidence of Inflammatory Bowel Disease in Asia, comparison of the more commonly seen causes of chronic inflammation of the gastrointestinal tract with a condition that appears to have a growing incidence in the region is necessary for optimal diagnostic protocol, management, and quality of care.