Characterization and Clinical Behavior of Crohn's Disease Initially Presenting Predominantly as Colitis

Abstract

The presence of granulomas and segmental involvement of the colon in patients with Crohn's colitis may reflect a more virulent clinical course. Ileal pouch-anal anastomosis may be considered as an option in select patients with Crohn's colitis without small-bowel or perianal disease. Based on our data, patients with nongranulomatous pancolitis may be better candidates for sphincter-sparing surgery.

Clinical and pathological analysis of colonic Crohn's disease, including a subgroup with ulcerative colitis-like features

“…However, several other predominantly clinicalbased studies have evaluated patients with isolated colonic Crohn's disease, and in some of those studies, less comprehensive pathological analyses were performed. [25][26][27] For instance, in 2003, Morpurgo et al 25 evaluated the clinical and (selected) pathology features, and outcome after surgery, of 92 patients with Crohn's disease of the colon at initial presentation. In that study, patients were specifically separated into two broad categories based on the presence or absence of granulomas.…”

“…Other studies have shown that some pathological features, such as granulomas, may be associated with recurrence after surgery; however, this is controversial. [40][41][42] Furthermore, other than the study by Morpurgo et al, 25 these studies did not evaluate isolated colonic Crohn's disease specifically.…”

Family History and Serology Predict Crohn's Disease after Ileal Pouch-Anal Anastomosis for Ulcerative Colitis

“…Although the presence of granulomas is conclusive, 41 many studies have also included 'minor' pathologic criteria such as transmural inflammation, discontinuous disease, and fissuring ulcers in the surgical specimen to establish the diagnosis of CD immediately after colectomy. 7,9,12,15,16,34,39,[42][43][44][45][46][47] We consider patients with these minor criteria to have IC and not CD since these features can not only be observed in fulminant UC but may also reflect treatment effect. Furthermore, we found no significant difference in clinical outcome (i.e., CD development) after IPAA between the UC, IBD-U, and IC patient subgroups.…”

A contemporary and critical appraisal of ‘indeterminate colitis‘

“…However, in another study of 21 CD patients with UC-like pancolitis at presentation, all of whom underwent a pouch procedure, only 14% had pouch complications that necessitated pouch resection, which is substantially lower than published rates of pouch complications in patients with classic features of CD in the colon. 70 Thus, more research is needed in order to determine if patients with UC-like colonic CD can be treated safely and reliably with total colectomy and IPAA. Figure 4 Patient with known UC, without ileitis, and without any major features of CD who developed a 15 cm segment of severe chronic active duodenitis.…”

“…1 A small percentage of patients with clinically and/or serologically defined CD, with involvement of the colon, or the colon and distal ileum, may show UC-like pathologic changes in their resection specimen, such as mucosal-only disease (without mural involvement), isolated rectal involvement, or diffuse colonic disease. [67][68][69][70] Patients with these features have been termed 'superficial' (UC-like) CD ( Figure 5). Essentially, patients with superficial (UC-like) CD have either ambiguous, or CD-like features, clinically, and UClike features pathologically.…”