Do standardization and quantification of histopathological criteria improve the diagnosis of inflammatory bowel disease?

Abstract

Introduction: Inflammatory bowel disease comprises two major categories: Crohn's disease and ulcerative rectocolitis, both with different clinical and histological aspects, causing sometimes significant morbidity. Objectives: Choose and apply standardized and quantified histopathological diagnosis method, and compare the results and quality index with the original diagnosis. Materials and methods: 43 histological colonoscopic biopsies of 37 patients were re-evaluated by standardized system. Results and discussion: The original diagnoses were more inconclusive (23.3%) than those standardized (2.3%). The agreement with gold standard (clinical, colonoscopical, and radiological diagnosis) was higher on standardized diagnoses (95.3%) than in original (74.4%), especially in relation to Crohn's disease, which percentages were 92.3% and 46.1%, respectively. The quality index was calculated in conclusive diagnosis of each method. For ulcerative rectocolitis, both methods showed sensitivity and negative predictive value of 100%; otherwise the original diagnosis demonstrated specificity of 85.7%, positive predictive value of 96.3% and accuracy of 97.0%, and the standardized diagnosis 92.3%, 96.7% and 97.6%, respectively. For Crohn's disease, there is specificity and positive predictive value of 100% in both methods; the original diagnosis showed sensitivity of 85.7%, negative predictive value of 96.3% and accuracy of 97%, while for the standardized diagnoses 92.3%, 96.7%, and 97.6%, respectively. Conclusion: The standardized diagnosis presented a higher percentage of correct and conclusive diagnoses than those presented in the original diagnosis, especially for Crohn's disease, as well as equal or slightly higher values in some quality index.

The relationship between the commensal microbiota levels and Crohn's disease activity

“…Crohn's disease (CD) is a chronic granulomatous inflammatory disorder that may affect any portion of the gastrointestinal tract (GI tract). 1,2 While the precise etiology remains unclear, several studies suggest that intestinal inflammation arises due to an abnormal response of the intestinal immune system to the fecal microbiota in genetically predisposed individuals. [3][4][5][6][7] The human gut harbors more than 10 14 microorganisms, comprising more than 500-1000 species, [8][9][10] including bacterial, microeukaryotic, and viral populations, 11 which form a unique ecosystem allowing a symbiotic relationship.…”

“…Crohn's disease (CD) is a chronic granulomatous inflammatory disorder that may affect any portion of the gastrointestinal tract (GI tract) . While the precise etiology remains unclear, several studies suggest that intestinal inflammation arises due to an abnormal response of the intestinal immune system to the fecal microbiota in genetically predisposed individuals …”