Clinical and pathological correlations in inflammatory bowel disease
Richard G. Farmer, M.D.
Department of Gastroenterology
William A. Hawk, M.D.
Department of Pathology
Rupert B. Turnbull, M.D.
Associate Emeritus Consultant, Department of Colon and Rectal Surgery
A decade ago, we1 and others2 emphasized the importance of correlation between clinical and pathological features in inflammatory bowel disease (IBD). These studies demonstrated that most cases of IBD could be differentiated into Crohn’s disease or ulcerative colitis, although a small number had indecisive features, both clinically and histologically. There were 16 (11%) such patients in our study.1 Further, despite much emphasis on the non-caseating sarcoid-type granuloma for the diagnosis of Crohn’s disease, our study documented this finding in only 55% of those with Crohn’s disease confirmed by other histologic criteria.1 That the problem of exact histologic differentiation of ulcerative colitis and Crohn’s disease persists has been recently reaffirmed by Kirsner3 who stated "typical pathological findings notwithstanding, the features in an individual case may be indecisive.” He also noted that “granulomas are identified in approximately 50% of patients.”
Because of our continued interest in this subject, and to reevaluate our experience in the histologic confirmation of the diagnosis of IBD, we undertook a study of 366 consecutive surgically resected specimens from patients with known IBD clinically.
There were 121 patients with a diagnosis of ulcerative colitis and 245 with Crohn’s disease. Pathological features are listed in the Table.
Thus, highly characteristic pathological features correlated with the characteristic clinical features of the diseases. In ulcerative colitis, the most characteristic histologic criterion was finding a crypt abscess in 95% of cases. Correlating with this finding were the mucosal changes grossly, the relative lack of transmural involvement, and the complete absence of granulomas. . . .