Differential diagnosis in inflammatory bowel disease colitis: State of the art and future perspectives

Abstract

Distinction between Crohn's disease of the colon-rectum and ulcerative colitis or inflammatory bowel disease (IBD) type unclassified can be of pivotal importance for a tailored clinical management, as each entity often involves specific therapeutic strategies and prognosis. Nonetheless, no gold standard is available and the uncertainty of diagnosis may frequently lead to misclassification or repeated examinations. Hence, we have performed a literature search to address the problem of differential diagnosis in IBD colitis, revised current and emerging diagnostic tools and refined disease classification strategies. Nowadays, the differential diagnosis is an untangled issue, and the proper diagnosis cannot be reached in up to 10% of patients presenting with IBD colitis. This topic is receiving emerging attention, as medical therapies, surgical approaches and leading prognostic outcomes require more and more disease-specific strategies in IBD patients. The optimization of standard diagnostic approaches based on clinical features, biomarkers, radiology, endoscopy and histopathology appears to provide only marginal benefits. Conversely, emerging diagnostic techniques in the field of gastrointestinal endoscopy, molecular pathology, genetics, epigenetics, metabolomics and proteomics have already shown promising results. Novel advanced endoscopic imaging techniques and biomarkers can shed new light for the differential diagnosis of IBD, better reflecting diverse disease behaviors based on specific pathogenic pathways.

Gleaning Insights from Fecal Microbiota Transplantation and Probiotic Studies for the Rational Design of Combination Microbial Therapies

“…UC pathology is characterized by diffuse mucosal inflammation and histological alterations limited to the mucosal layer of the colon (200). The inflammation seen in UC is chronic but waxes and wanes in intensity.…”

Urinary metabolites as noninvasive biomarkers of gastrointestinal diseases: A clinical review

“…Determination of disease biomarkers in easily obtainable biofluids like urine, therefore, would be a valuable adjunct or even an alternative to conventional methods. Many serological markers for inflammatory bowel diseases (IBD) already exist, however, they are less helpful in determining disease subtypes (i.e., Crohn's disease and ulcerative colitis) or forms of indeterminate colitis [5] . Biomarkers or biomarker profiles that can predict and discriminate these subtypes with high probability are therefore desirable.…”

Genetic and Serological Markers in Identifying Unclassified Colitis

“…The overall sensitivity of the newer anti-glycan antibodies in CD is low [1]; however, combining different serum biomarkers increases the predictive value for differentiating CD from UC. Being ASCA positive and pANCA negative increases the specificity and positive predictive value for diagnosis of CD compared to ASCA positivity alone [11].…”

“…In about 5-15% of the patients with inflammation limited to the colon, it is difficult to distinguish between UC and Crohn's colitis [1]. These cases of overlap, previously referred to as indeterminate colitis, are now called unclassified IBD [2].…”