Ileitis in Ulcerative Colitis: Is It a Backwash?

Abdelrazeq, Ayman S.; Wilson, Timothy R.; Leitch, Derek L.; Lund, Jonathan N.; Leveson, Stephen H.

doi:10.1007/s10350-005-0160-3

Cited by 68 publications

(51 citation statements)

References 33 publications

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“…Some observers have suggested that backwash ileitis is a primary ileal disease that occurs in patients with ulcerative colitis, and our observation of markedly decreased CD10 staining in this setting, seemingly out of proportion to that found even in cases of Crohn's disease, may lend weight to this argument. 25,26 Furthermore, previous studies have suggested that ileal mucosa is altered in other phenotypic ways, such as mucosal permeability and mucin expression, in the setting of backwash ileitis and/or pouchitis, in which a more 'colon-like' mucin pattern has been noted. 27,28 We have demonstrated a variable loss of brush border CD10 immunostaining in the setting of active enteritis.…”

Section: Discussionmentioning

confidence: 99%

CD10 immunohistochemistry stains enteric mucosa, but negative staining is unreliable in the setting of active enteritis

Lloyd

Owens

2011

Modern Pathology

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Ileal pouch-anal anastomosis is the definitive therapy for ulcerative colitis that is refractory to medical treatment or that has developed neoplasia. Patients with this procedure are routinely followed using directed endoscopic biopsies to monitor for dysplasia in the rectal cuff, residual/recurrent ulcerative colitis, and nonspecific acute inflammation of the ileal pouch (pouchitis), which have different clinical management and outcomes. Thus, accurate localization of mucosal biopsies is crucial to a definitive histological diagnosis, but is complicated by overlapping clinical presentations of pouchitis and ulcerative colitis, post-surgical and inflammatory changes to the mucosa, and altered endoscopic anatomy, resulting in difficulty determining whether a mucosal biopsy is ileal or rectal in origin for both the endoscopist and the pathologist. We explored the utility of CD10 immunohistochemistry to aid diagnosis in this clinical setting by highlighting the enteric mucosa, based on previous studies showing its utility in brush border staining and in the diagnosis of microvillous inclusion disease. We found uniformly positive CD10 immunostaining in normal enteric mucosa, but variable loss of expression in the setting of active enteritis. Specifically, CD10 staining was lost in up to 10% of the mucosa in 1/12 ileostomies and 4/13 enteric anastomoses, in 10-80% of the mucosa in 9/10 cases of Crohn's ileitis, in 10-60% of the mucosa in 7/16 ileal pouches, and in 20-90% of the mucosa in 6/8 cases of backwash ileitis, usually in the presence of active inflammation. There was no CD10 expression by normal or diseased colonic mucosa. Therefore, while CD10 immunostaining identifies normal enteric mucosa with 100% specificity, negative staining does not definitively exclude small intestinal mucosa in the setting of active enteritis, a common condition in ileal pouch mucosa.

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Section: Discussionmentioning

confidence: 99%

CD10 immunohistochemistry stains enteric mucosa, but negative staining is unreliable in the setting of active enteritis

Lloyd

Owens

2011

Modern Pathology

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“…Being one of the most important protein in acute inflammation [41], it sharply increases to very high levels that may reach 350-400 mg/L with acute inflammation while lesser levels of elevation in the range of 10-40 mg/L may indicate chronic inflammation as IBD. However, for unknown mechanism, it correlates significantly with CD but not UC [42,43] while high-sensitivity C-reactive protein (hs-CRP) and β2-microglublin correlate with histology scores of UC [44]. To summarize, CRP can be falsely low despite active mucosal inflammation while it is more reliable in transmural inflammation [45].…”

Section: C-reactive Protein (Crp)mentioning

confidence: 99%

Bio-Markers of Inflammatory Bowel Disease: Past, Present, and Future

Bahgat¹

2017

Austin J Gastroenterol

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Ulcerative colitis (UC) and Crohn's disease (CD) exemplify the two main arms of the spectrum of an idiopathic chronic disease known as inflammatory bowel disease (IBD). To date, this disease remained a puzzling dilemma in many aspects; including difficulties in its etiology/pathogenesis, diagnosis, severity assessment, treatment and outcomes/complications. Physicians usually get the diagnosis of IBD through a combination of clinical features, laboratory tests, radiology, as well as the invasive technique of endoscopy/biopsy. In spite of these efforts, the definite diagnosis can't be established in a significant cohort of cases. This paved the way to searching for laboratory biomarkers that are noninvasive, reproducible, rapid and relatively cheap than other modalities. Unfortunately, we're still far from these ideal biomarkers. Some biomarkers are already being used in daily practice including C-reactive protein (CRP) and fecal calprotectin while others are still in need for confirmation before being applied in clinical practice. In this review article, the authors are going to discuss the past, present, and future utility of biomarkers in IBD. This article aims at highlighting the uses and limitations of all possible current and novel biomarkers in every aspect of the disease from predisposition to prognosis.

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“…These include backwash-induced inflammation (backwash ileitis), infection (typically viral), the effects of drugs (such as NSAIDs), or the effects of bowel preparatory agents. [53][54][55][56][57][58][59][60][61] Backwash ileitis represents inflammation of the distal few centimeters of ileum because of inflammation-induced incompetence of the ileocecal valve and subsequent reflux of colonic contents into the ileum, which, presumably, causes inflammation. 54,56,57 Thus, backwash ileitis should only be considered in UC patients who have at least moderate-to-severe involvement of the cecum, and with involvement of the area of mucosa surrounding the ileocecal valve.…”

Section: Uc With Crohn's-like Featuresmentioning

confidence: 99%

“…In one study 55,[58][59][60][61] consisting of 50 patients with UC, 16% had ileal inflammation without involvement of the cecum indicating that Figure 3 High-power image of a ruptured crypt and associated granuloma in a patient with UC. These granulomas may only be recognized as associated with a ruptured crypt by cutting deeper levels of the tissue block in order to identify remnants of the crypt epithelium.…”

Section: Uc With Crohn's-like Featuresmentioning

confidence: 99%

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A contemporary and critical appraisal of ‘indeterminate colitis‘

Odze

2015

Modern Pathology

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Distinguishing ulcerative colitis (UC) from Crohn's disease (CD) is normally based on evaluation of a variety of clinical, radiologic, serologic and pathologic findings, the latter in biopsy and/or resection specimens. Unfortunately, some patients with IBD show overlapping pathologic features of UC and CD, which makes definite distinction between these two disorders difficult or even impossible. In most instances of uncertainty, the patient shows clinical and pathologic features of UC, but in addition, the patient's colon resection specimen reveals one or more CD-like features. In this setting, a diagnosis of indeterminate colitis (IC) is often rendered. IC is not a distinct disease entity, and, thus, it has no diagnostic criteria. The most common causes of uncertainty in IBD pathology that may lead to a diagnosis of IC in a colon resection specimen includes the presence of fulminant (severe and toxic) colitis, insufficient radiologic, endoscopic, or pathologic information (including analysis of prior biopsies) on the patient, failure to utilize major diagnostic criteria as hard evidence in favor of CD, failure to recognize unusual variants of UC and CD that may mimic each other, failure to recognize non-IBD mimics and other superimposed diseases that cause unusual pathologic features in a resection specimen, an attempt to distinguish UC from CD in mucosal biopsies of the colon and ileum, or an attempt to change the patients diagnosis (of UC or CD) based on pouch or diversion-related complications. Details of each of these causes of uncertainty are discussed, in detail, in this review article. A diagnosis of IC should never be made clinically or by pathologists based on evaluation of pre-resection colonic mucosal biopsies. Ultimately, the majority of indeterminate cases represent UC, and, thus, most of these patient can be treated safely with a colectomy combined with an ileal pouch anal anastomosis procedure.

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Ileitis in Ulcerative Colitis: Is It a Backwash?

Cited by 68 publications

References 33 publications

CD10 immunohistochemistry stains enteric mucosa, but negative staining is unreliable in the setting of active enteritis

CD10 immunohistochemistry stains enteric mucosa, but negative staining is unreliable in the setting of active enteritis

Bio-Markers of Inflammatory Bowel Disease: Past, Present, and Future

A contemporary and critical appraisal of ‘indeterminate colitis‘

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