Histopathology of inflammatory bowel disease — Position statement of the Pathologists of the Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD) and Italian Group of Gastrointestinal Pathologists (GIPAD-SIAPEC)

Histopathology of IBD Colitis. A practical approach from the pathologists of the Italian Group for the study of the gastrointestinal tract (GIPAD)

“…In patients with suspected IBD, histological examination should be performed before initiation of treatment because drugs can induce changes in morphology 4 . All the different segments of the ileo-colic tract should be extensively sampled, regardless of the endoscopic extension of the disease 2 , 30 . Endoscopic sampling is required also during follow-up to assess the therapeutic efficacy in mucosal healing and for cancer prevention 29 .…”

“…If the upper digestive tract is suspected to be involved, esophageal, gastric and duodenal biopsies are indicated 31 . The minimum sampling during follow-up consists in at least two biopsies in all large bowel tracts showing significant lesions and two biopsies in the rectum 2 , 30 . In case of discordance between the initial histological diagnosis and the clinical course during follow-up, it is mandatory to repeat a complete sampling to settle the question.…”

“…To better evaluate all histological parameters required for a diagnosis of IBD and to distinguish UC and CD, the use of appropriate cellulose acetate filters is highly recommended 29 , 30 . In detail, after sampling the mucosa, the endoscopist can place each fragment upright in a straight line with proximal-to-distal orientation onto the cellulose acetate filter, which relies on a clarinet beak-shaped cut for orientation (Bio-Optica, Milan, Italy).…”

“…In detail, after sampling the mucosa, the endoscopist can place each fragment upright in a straight line with proximal-to-distal orientation onto the cellulose acetate filter, which relies on a clarinet beak-shaped cut for orientation (Bio-Optica, Milan, Italy). All tissue samples should be fixed immediately by immersion in 10% buffered formalin and, after adequate fixation, processed and paraffin-embedded with 90°-rotation by the technician, in order to ensure the best trans-sectional cut 30 . Since lesions may be focal, multiple sections from each tissue sample should be examined 2 , 29 .…”

Good efficacy and safety of vedolizumab in Crohn’s disease and ulcerative colitis in a real-world scenario

“…As secondary outcomes, we reported: the endoscopic response as a decrease of at least 1 point of the endoscopic Mayo score in the case of UC; a decrease of 50% from the baseline SES-CD and Rutgeerts scores at the endoscopic 1-year re-evaluation in the case of CD; and the histological response , as the evidence of inactive state at the histological evaluation according to a recent Italian position statement. 26 The treatment failure was defined as discontinuation of biological therapy due to adverse events, lack of clinical response and need of hospitalization/surgery. A sub-analysis was conducted considering subjects who started VDZ in a remission state to evaluate the remission persistence.…”