IBD. Crohn s. Outline. Ulcerative colitis versus Crohn s disease: is biopsy useful? UC vs. Crohn s? Is it easy? Biopsy settings 21/07/2017 IBD
|
|
- Mercy McCoy
- 5 years ago
- Views:
Transcription
1 Outline Ulcerative colitis versus Crohn s disease: is biopsy useful? Roger Feakins Colorectal biopsies Ileal and upper GI biopsies Special situations New techniques Summary Inflammatory bowel disease (IBD) = chronic idiopathic inflammatory bowel disease UC vs. Crohn s? Is it easy? 10-15% Crohn s reclassified as UC after 1 year IBD Never classified: 1-20% IBD unclassified (IBDU) Indeterminate colitis in resections UC Crohn s Reclassified even after resection UC colectomy: 24% re-diagnosed as Crohn's Stange EF et al (ECCO) 2008; Odze R 2015; Silverberg MS 2005; Jones I 2017 Biopsy settings IBD UC (IBDU) Crohn s New IBD / suspected new IBD Treated / longstanding IBD 1
2 (Imaging) Stool culture Endoscopy NEW IBD VS NON-IBD Symptoms, clinical course IBD? Infection? Other? Histology Basic principles of IBD diagnosis IBD > non-ibd (initial biopsies) Basal plasmacytosis Basal plasmacytosis Architectural changes Crypt distortion Crypt atrophy Irregular or villiform mucosal surface Plasma cells at base of mucosa + loss of plasma cell gradient Significance: Earliest feature of IBD Best predictor of IBD Other features (less discriminatory) Granulomas Mucin depletion Lymphoid aggregates Crypts with their feet in pools of plasma cells Schumacher G. 1994; Stange EF, Travis SPL 2008 Architectural changes: crypt distortion and atrophy IBD CANNOT BE CLASSIFIED IF IT S NOT IBD Dilatation Branching Loss of parallelism Variation in size and shape 2
3 IBD? IBD? Diverticular colitis Architectural changes Basal plasmacytosis Crohn s disease on endoscopy? Lymphogranuloma venereum (LGV) Histology Chronic inflammation No/minimal basal plasmacytosis No/minimal crypt distortion Rectal biopsy Rectal biopsy Biopsy settings IBD Not IBD UC (IBDU) Crohn s New IBD / suspected new IBD Treated / longstanding IBD Histology less reliable for UC vs Crohn s 3
4 Clinical features UC Crohn s Blood in stools > 90% < 50% Distribution Continuous Discontinuous UC VS CROHN S Endoscopic features Erythema, granularity, ulceration Longitudinal ulcers, cobblestoning Perianal disease Uncommon Fistulas and fissures common Small bowel strictures Very rare Not uncommon UC vs Crohn s: considerations for the pathologist Distribution of changes What is assessed? Architectural changes Chronic inflammation Distribution in biopsies Granulomas Where? Within a biopsy Diffuse, patchy, focal Mucin depletion Between biopsies Between anatomical sites Continuous, discontinuous Basic principles of IBD diagnosis UC > Crohn s (initial biopsies) Typical UC In any biopsy Diffuse crypt changes Diffuse chronic inflammation Severe mucin depletion (Extensive activity) (Presence of crypt changes) In biopsies from multiple sites Continuous crypt changes Absence of ileitis Distal > proximal Diffuse changes within a biopsy Diffuse changes between biopsies 4
5 Crohn s disease > UC (initial biopsies) Typical Crohn s disease In any biopsy Granulomas** Non-diffuse crypt distortion Non-diffuse chronic inflammation Non-diffuse crypt distortion Granuloma In biopsies from multiple sites Anatomical discontinuity Ileal inflammation Proximal > distal; rectal sparing Non-diffuse chronic inflammation Granuloma Paneth cell metaplasia 20% of Crohn s biopsies..at least five epithelioid macrophages Not always Crohn s TB, parasite, foreign material, drug, sarcoid, etc. Cryptolytic granulomas also in UC and other colitides Paneth cells Not significant proximal to splenic flexure Distally? 17 % rectal biopsies Discriminatory value Chronicity IBD > non-ibd Seen in GVHD, radiation colitis, collagenous colitis Pezhouh MK 2016; Simmonds N 2014; Ayata 2002 Paneth cells No single feature is diagnostic Multiple features increase accuracy DISCONTINUOUS UC IBD diagnosis: is biopsy best? 5
6 Discontinuity in UC Discontinuity in UC New UC New UC Longstanding UC Caecal patch Up to 75% Caecal patch Up to 75% Common Absolute rectal sparing 0-5% Relative rectal sparing 31% Absolute rectal sparing 0-5% Relative rectal sparing 31% 15-44% Focal or patchy changes Uncommon Focal or patchy changes Uncommon 30-38% Caecal patch D'Haens G 1997 Odze 1993; Bernstein 1995; Kleer 1998; Kim 1999; D'Haens G 1997 Discontinuity in UC New UC Longstanding UC Caecal patch Up to 75% Common Absolute rectal sparing 0-5% Relative rectal sparing 31% 15-44% Focal or patchy changes Uncommon 30-38% Normalisation 10% ILEAL BIOPSY Odze 1993; Bernstein 1995; Kleer 1998; Kim 1999; D'Haens G 1997; Christensen B 2017 UC vs CD: ileal inflammation Favours Crohn s Also 17% of UC Ileal feature UC Crohn s Granuloma No Yes Pyloric metaplasia Rare Yes Villous atrophy Yes Yes Focal cryptitis / crypt abscesses / erosions Yes Yes Patchy laminaproprial neutrophils Yes Yes UPPER GI Haskell H et al. 2005; Geboes K et al
7 21/07/2017 UC vs CD: Upper GI inflammation Exclude other causes Reflux Helicobacter Drugs Crohn s UC Oesophagitis 46-72% 15-50% Gastritis 59-81% 58-77% Duodenitis 40-53% 17-19% Tobin JM, Sinha B 2001; Bousvaros A 2007 UGI granulomas Crohn s UC Oesophagus 0-33% 0 Stomach 6-37% 0 Duodenum 2-11% 0 Upper GI 19-78% 0 Schmitz-Moormann, Malchow 1985; Wright CL 1998; Tobin JN 2001; Alcantara 1993; Horjus Talabur Horje CS 2016 UGI UC Focally enhanced gastritis Histology Mixed inflammatory infiltrate around glands and foveolae Epithelial damage Crohn s Focally enhanced gastritis 12-54% UC 21-23% Oberhuber G 1997; McHugh JB 2013 Gastric UC 1. Focal gastritis 2. Patchy mixed basal inflammation 3. Superficial plasmacytosis Duodenal UC Diffuse duodenitis Rare Resembles colonic changes Lin J. Am J Surg Pathol 2010 Early IBD SPECIAL SITUATIONS % Basal plasma cells Crypt distortion Crypt atrophy Villous surface < 16 days days 1-4 months > 4 months Duration of symptoms Granulomas after 25 days Schumacher G
8 Paediatric UC UC vs CD post-operatively Setting Confusing feature UC vs CD Feature Adults Children Diffuse continuous disease 100% 68% Pouch / pre-pouch ileum Diversion proctocolitis Fissures, fistulas, granulomas can occur Histology resembles UC Granulomas do not necessarily indicate Crohn s Diffuse crypt abnormalities 58% 32% Severe crypt atrophy 21% 6% Granulomas / granulomatous vasculitis can occur Granulomas do not necessarily indicate Crohn s Patchiness of chronic changes 0% 21% Washington K 2002 Granulomas in diversion proctocolitis Primary sclerosing cholangitis (PSC) Prevalence Most PSC develop IBD 2% IBD develop PSC Type of IBD 80-90% UC Pancolitis (if IBD precedes PSC) Right-sided UC (if PSC precedes IBD) 10% Crohn s Usually involves colon Validity of UC/Crohn s label? ACCURACY OF BIOPSY DIAGNOSIS de Vries 2015; Joo M 2009; Boonstra K 2012; Schaeffer DF 2013 Accuracy of colorectal biopsy Better at confirming IBD than classifying it Rectal biopsy predicts 70% UC and 40% Crohn s Crohn's (non-experts) Crohn's (experts) UC (non-experts) UC (experts) % accuracy multiple site biopsies DO WE NEED HISTOPATHOLOGISTS? Bentley E 2002; Cross SS
9 Confocal laser endomicroscopy Magnification x 1400 New techniques? UC Crohn s p value Discontinuous inflammation 5 87 < Discontinuouscrypt changes < Focal cryptitis < Severe widespread crypt distortion < Irregular surface < Disturbed architecture Colonic crypts regularly arranged Scoring system: 93.7 % accurate Neumann H, Kiesslich R 2013 Tontini GE 2014 Summary: UC vs Crohn s in colorectal biopsy Summary: UC vs Crohn s in ileal and UGI biopsy Category of abnormality Discriminatoryvalue Site Comment Granulomas (20% Crohn s biopsies) ++++ Distribution of crypt changes +++ Distribution of chronic inflammation ++ Severity of mucin depletion + Ileal Upper GI Involvement favours Crohn s Granulomas discriminate Granulomas discriminate Extent of activity + Summary: UC vs Crohn s - special or difficult situations Histology enhances or completes the picture Special situation Discontinuity in new UC Caecal patch; rectal sparing Longstanding UC Discontinuity, rectal sparing Imaging Histology Early IBD Absence of architectural changes Paediatric UC Discriminatory changes less common Endoscopy Symptoms PSC-related IBD Non-conformism Pouch, pre-pouch, diversion proctocolitisin UC +/- Crohn s-like features and granulomas Past history 9
10 THANK YOU 10
The pathology of IBD and its modification by liver disease. Roger Feakins ESP/H-ECCO
The pathology of IBD and its modification by liver disease Roger Feakins ESP/H-ECCO Enterprise Interest None IBD UC [IBDU] Crohn s IBD: distribution of disease Ulcerative colitis continuous Crohn s colitis
More informationPatho Basic Chronic Inflammatory Bowel Diseases. Jürg Vosbeck Pathology
Patho Basic Chronic Inflammatory Bowel Diseases Jürg Vosbeck Pathology General Group of chronic relapsing diseases with chronic bloody or watery diarrhea Usually ulcerative colitis (UC) or Crohn s disease
More informationPitfalls in the Diagnosis of Inflammatory Bowel Disease
Pitfalls in the Diagnosis of Inflammatory Bowel Disease Robert H Riddell MD Mt Sinai Hospital Toronto Prof of Lab. Medicine and Pathobiology University of Toronto Atypical gross / endoscopic distribution
More information하부위장관비종양성질환의 감별진단 주미인제의대일산백병원
하부위장관비종양성질환의 감별진단 주미인제의대일산백병원 Solutions for diagnostic problems in Colitis : Please ask yourself five questions Normal or Inflamed? Acute or Chronic? IBD or Other chronic colitis? Ulcerative colitis or
More informationSAMs Guidelines DEVELOPING SELF-ASSESSMENT MODULES TEST QUESTIONS. Ver. #
SAMs Guidelines DEVELOPING SELF-ASSESSMENT MODULES TEST Ver. #5-02.12.17 GUIDELINES FOR DEVELOPING SELF-ASSESSMENT MODULES TEST The USCAP is accredited by the American Board of Pathology (ABP) to offer
More informationINTERNATIONAL COURSE ON THE PATHOLOGY OF THE DIGESTIVE SYSTEM VICTOR BABES NATIONAL INSTITUTE OF PATHOLOGY BUCHAREST 7-8 BUCHAREST 2014
INTERNATIONAL COURSE ON THE PATHOLOGY OF THE DIGESTIVE SYSTEM VICTOR BABES NATIONAL INSTITUTE OF PATHOLOGY BUCHAREST 7-8 BUCHAREST 2014 Endoscopic biopsy samples of naïve colitides patients: Role of basal
More informationFocally Enhanced Gastritis in Newly Diagnosed Pediatric Inflammatory Bowel Disease
Focally Enhanced Gastritis in Newly Diagnosed Pediatric Inflammatory Bowel Disease The Harvard community has made this article openly available. Please share how this access benefits you. Your story matters
More informationCase History B Female patient 1970 Clinical History : crampy abdominal pain and episodes of bloody diarrhea Surgical treatment
Case History B-1325945 Female patient 1970 Clinical History : crampy abdominal pain and episodes of bloody diarrhea Surgical treatment Case History B-1325945 Pathology Submucosa & Muscularis Endometriosis
More informationPatterns of Colonic Involvement at Initial Presentation in Ulcerative Colitis A Retrospective Study of 46 Newly Diagnosed Cases
Anatomic Pathology / PATTERNS OF INVOLVEMENT IN ULCERATIVE COLITIS Patterns of Colonic Involvement at Initial Presentation in Ulcerative Colitis A Retrospective Study of 46 Newly Diagnosed Cases Marie
More informationThe revised Porto criteria for diagnosing
R E S E A R C H P A P E R Long-term Outcome of Inflammatory Bowel Disease Unclassified in Children SIBA PROSAD PAUL AND BHUPINDER KAUR SANDHU From Bristol Royal Hospital for Children, Upper Maudlin Street,
More informationWhat do we need for diagnosis of IBD
What do we need for diagnosis of IBD Kaichun Wu Dept. of Gastroenterology, Xijing Hospital Fourth Military Medical University Xi an an,, China In China UC 11.6/10 5,CD 1.4/10 5 Major cause of chronic diarrhea
More informationBIOPSY DIAGNOSIS OF COLITIS Common and Unusual Forms of Inflammatory Bowel disease
BIOPSY DIAGNOSIS OF COLITIS Common and Unusual Forms of Inflammatory Bowel disease David A Owen University of British Columbia CAUSES OF DIARRHEA DIARRHEA COLITIS PRESENT COLITIS ABSENT INFECTIOUS NON-INFECTIOUS
More informationBiopsy Evaluation of Non- Neoplastic Diseases of the Large Bowel: an algorithmic approach
Biopsy Evaluation of Non- Neoplastic Diseases of the Large Bowel: an algorithmic approach Laura W. Lamps, M.D. Godfrey D. Stobbe Professor and Director of GI Pathology University of Michigan Health System
More informationHow to differentiate Segmental Colitis Associated with Diverticulosis and Inflammatory Bowel Diseases?
How to differentiate Segmental Colitis Associated with Diverticulosis and Inflammatory Bowel Diseases? Alessandro Armuzzi Lead IBD Unit Complesso Integrato Columbus Fondazione Policlinico Gemelli Università
More informationT he distinction between ulcerative colitis
1233 REVIEW Indeterminate colitis M Guindi, R H Riddell... Indeterminate colitis (IC) originally referred to those 10 15% of cases of inflammatory bowel disease (IBD) in which there was difficulty distinguishing
More informationIBD 101. Ronen Stein, MD Assistant Professor of Clinical Pediatrics Division of Gastroenterology, Hepatology, and Nutrition
IBD 101 Ronen Stein, MD Assistant Professor of Clinical Pediatrics Division of Gastroenterology, Hepatology, and Nutrition Objectives Identify factors involved in the development of inflammatory bowel
More informationGUIDELINES FOR THE INITIAL BIOPSY DIAGNOSIS OF CHRONIC IDIOPATHIC INFLAMMATORY BOWEL DISEASE A STRUCTURED APPROACH TO COLORECTAL BIOPSY ASSESSMENT
Guidelines for the Initial Biopsy Diagnosis of Chronic Idiopathic Inflammatory Bowel Disease 1 GUIDELINES FOR THE INITIAL BIOPSY DIAGNOSIS OF CHRONIC IDIOPATHIC INFLAMMATORY BOWEL DISEASE A STRUCTURED
More informationOriginal Article. Atypical histological features of ulcerative colitis. Siddharth N Shah, 1 Anjali D Amarapurkar, 1 N Shrinivas, 2 Rathi PM 2 ABSTRACT
Tropical Gastroenterology 2011;32(2):107 111 Original Article Atypical histological features of ulcerative colitis Siddharth N Shah, 1 Anjali D Amarapurkar, 1 N Shrinivas, 2 Rathi PM 2 ABSTRACT Department
More informationEndoscopy in IBD. F.Hartmann K.Kasper-Kliniken (St.Marienkrankenhaus) Frankfurt/M.
F.Hartmann K.Kasper-Kliniken (St.Marienkrankenhaus) Frankfurt/M. F.Hartmann@em.uni-frankfurt.de Indications for endoscopy Diagnosis Management Surveillance Diagnosis Single most valuable tool: ileocolonoscopy
More informationSURGICAL MANAGEMENT OF ULCERATIVE COLITIS
SURGICAL MANAGEMENT OF ULCERATIVE COLITIS Cary B. Aarons, MD Associate Professor of Surgery Division of Colon & Rectal Surgery University of Pennsylvania AGENDA Background Diagnosis/Work-up Medical Management
More informationPage 1. Is the Risk This High? Dysplasia in the IBD Patient. Dysplasia in the Non IBD Patient. Increased Risk of CRC in Ulcerative Colitis
Screening for Colorectal Neoplasia in Inflammatory Bowel Disease Francis A. Farraye MD, MSc Clinical Director, Section of Gastroenterology Co-Director, Center for Digestive Disorders Boston Medical Center
More informationDiagnostic difficulties in inflammatory bowel disease pathology
Histopathology 2006, 48, 116 132. DOI: 10.1111/j.1365-2559.2005.02248.x REVIEW Diagnostic difficulties in inflammatory bowel disease pathology R K Yantiss & R D Odze 1 Departments of Pathology, Weill Medical
More informationReview Histological evaluation in ulcerative colitis
Gastroenterology Report 2 (2014) 178 192, doi:10.1093/gastro/gou031 Advance access publication 18 June 2014 Review Histological evaluation in ulcerative colitis Tom C. DeRoche 1, Shu-Yuan Xiao 2 and Xiuli
More informationWhat is your diagnosis? a. Lymphocytic colitis. b. Collagenous colitis. c. Common variable immunodeficiency (CVID) associated colitis
Case History A 24 year old male presented with fatigue, fever, watery diarrhea, and a cough with sputum production for the past three weeks. His past medical history was significant for recurrent bouts
More informationPATHOLOGY OF NON NEOPLASTIC LESIONS OF THE UPPER GASTROINTESTINAL TRACT.
PATHOLOGY OF NON NEOPLASTIC LESIONS OF THE UPPER GASTROINTESTINAL TRACT. OESOPHAGEAL LESIONS OESOPHAGITIS AND OTHER NON NEOPLASTIC DISORDERS Corrosive Gastroesophageal reflux (GERD), Pills, Acid intake,
More information11/1/2017. Tetyana Mettler, MD Department of Laboratory Medicine and Pathology University of Minnesota. Cerilli & Greenson
Tetyana Mettler, MD Department of Laboratory Medicine and Pathology University of Minnesota Acute infectious (self-limited) colitis Focal active colitis Pseudomembranous colitis Ischemic colitis Collagenous
More informationSAM PROVIDER TOOLKIT
THE AMERICAN BOARD OF PATHOLOGY Maintenance of Certification (MOC) Program SAM PROVIDER TOOLKIT Developing Self-Assessment Modules (SAMs) www.abpath.org The American Board of Pathology (ABP) approves educational
More informationThe histopathological approach to inflammatory bowel disease: a practice guide
DOI 10.1007/s00428-014-1543-4 REVIEW AND PERSPECTIVES The histopathological approach to inflammatory bowel disease: a practice guide Cord Langner & Fernando Magro & Ann Driessen & Arzu Ensari & Gerassimos
More informationWhat Every Pathologist Wants the GI Nurse to Know (and how you can help us help you)
What Every Pathologist Wants the GI Nurse to Know (and how you can help us help you) Jonathan N. Glickman MD PhD Director, GI Pathology, Caris Diagnostics, Newton, MA Associate Professor of Pathology,
More informationSurgical Management of IBD. Val Jefford Grand Rounds October 14, 2003
Surgical Management of IBD Val Jefford Grand Rounds October 14, 2003 Introduction Important Features Clinical Presentation Evaluation Medical Treatment Surgical Treatment Cases Overview Introduction Two
More informationHistopathology: gastritis and peptic ulceration
Histopathology: gastritis and peptic ulceration These presentations are to help you identify, and to test yourself on identifying, basic histopathological features. They do not contain the additional factual
More informationInflammatory Bowel Disease Ischemic bowel disease
Inflammatory Bowel Disease Ischemic bowel disease Inflammatory Bowel Disease The two disorders that comprise IBD are: ulcerative colitis Crohn disease The distinction between ulcerative colitis and Crohn
More informationKids Like to Break the Rules: Gastrointestinal Pathology in Children
Kids Like to Break the Rules: Gastrointestinal Pathology in Children Jeffrey Goldsmith MD Director of Surgical Pathology, Beth Israel Deaconess Medical Center; Consultant in Gastrointestinal Pathology,
More informationThe Morphologic Profile of Inflammatory Bowel Disease and the Diagnostic Problem of Crohn s Disease versus TB Colitis A Case Series
OPEN ACCESS CASE REPORT The Morphologic Profile of Inflammatory Bowel Disease and the Diagnostic Problem of Crohn s Disease versus TB Colitis A Case Series Maria Lourdes Tilbe, Francia Victoria De Los
More informationUpdate on the pathological classification of gastritis. Hala El-Zimaity, M.D. M.S. Epidemiology McMaster University Hamilton, Ontario Canada
Update on the pathological classification of gastritis Hala El-Zimaity, M.D. M.S. Epidemiology McMaster University Hamilton, Ontario Canada CLASSIFICATION GASTRITIS GASTROPATHY 1. Acute 2. Chronic 3. Uncommon
More informationFor the past 40 years, it has been standard practice to obtain
ORIGINAL ARTICLE: GASTROENTEROLOGY Good Agreement Between Endoscopic Findings and Biopsy Reports Supports Limited Tissue Sampling During Pediatric Colonoscopy Michael A. Manfredi, Hongyu Jiang, Lawrence
More informationEndoscopic mucosal biopsies are useful in distinguishing granulomatous colitis due to Crohn s disease from tuberculosis
Gut 1999;45:537 541 537 Wellcome Research Unit, Department of Gastrointestinal Sciences, Christian Medical College and Hospital, Vellore 632 004, Tamilnadu, India A B Pulimood B S Ramakrishna G Kurian
More informationThe Spectrum of IBD. Inflammatory Bowel Disease. Symptoms. Epidemiology. Tests for IBD. CD or UC? Inflamatory Bowel Disease. Fernando Vega, M.D.
The Spectrum of IBD Inflammatory Bowel Disease Fernando Vega, M.D. Epidemiology CD and UC together 1:400 UC Prevalence 1:500 UC Incidence 6-12K/annum CD Prevalence 1:1000 CD Incidence 3-6K/annum Symptoms
More informationINFLAMMATORY BOWEL DISEASE. Jean-Paul Achkar, MD Center for Inflammatory Bowel Disease Cleveland Clinic
INFLAMMATORY BOWEL DISEASE Jean-Paul Achkar, MD Center for Inflammatory Bowel Disease Cleveland Clinic WHAT IS INFLAMMATORY BOWEL DISEASE (IBD)? Chronic inflammation of the intestinal tract Two related
More informationNormal small intestine Variations
THE HISTOPATHOLOGICAL DIAGNOSIS OF THE TERMINAL ILEUM BIOPSY K. Geboes, MD, PhD, AGAF, dr. H.C. Belgium Normal small intestine Variations Duodenum Ileum 1 Proliferative compartment Normal variations 2
More informationDiagnostic and Therapeutic Approaches to Dysplasia in Inflammatory Bowel Diseases
Diagnostic and Therapeutic Approaches to Dysplasia in Inflammatory Bowel Diseases Parakkal Deepak, M.B.B.S., M.S. Assistant Professor of Medicine Division of Gastroenterology John T. Milliken Department
More informationInflammatory Bowel Disease When is diarrhea not just diarrhea?
Inflammatory Bowel Disease When is diarrhea not just diarrhea? Jackie Kazik, MA, PA C CME Resources CAPA Annual Conference, 2011 Inflammatory Bowel Disease Objectives Discuss what is known about the pathophysiology
More informationIBD 101. Ronen Stein, MD Assistant Professor of Clinical Pediatrics Division of Gastroenterology, Hepatology, and Nutrition
IBD 101 Ronen Stein, MD Assistant Professor of Clinical Pediatrics Division of Gastroenterology, Hepatology, and Nutrition Objectives Identify factors involved in the development of inflammatory bowel
More informationResearch Article Endoscopic and Pathologic Changes of the Upper Gastrointestinal Tract in Crohn s Disease
BioMed Research International, Article ID 610767, 6 pages http://dx.doi.org/10.1155/2014/610767 Research Article Endoscopic and Pathologic Changes of the Upper Gastrointestinal Tract in Crohn s Disease
More informationHistological and immunological characteristics of colitis associated with anti-ctla 4 antibody therapy
Histological and immunological characteristics of colitis associated with anti-ctla 4 antibody therapy M. Perdiki 2, G. Bamias 1, D. Pouloudi 2, H. Gogas 3, I. Delladetsima 2 1 Academic Dpt. of Gastroenterology,
More informationHow to characterize dysplastic lesions in IBD?
How to characterize dysplastic lesions in IBD? Name: Institution: Helmut Neumann, MD, PhD, FASGE University Medical Center Mainz What do we know? Patients with IBD carry an increased risk of developing
More informationChronic Colitis Pattern Christina A. Arnold, M.D. The Ohio State University Wexner Medical Center Columbus, Ohio
Chronic Colitis Pattern Christina A. Arnold, M.D. The Ohio State University Wexner Medical Center Columbus, Ohio Identify this medication resin: A. Bile Acid Sequestrant B. Kayexalate C. Sevelamer D. Renvela
More informationTreating Crohn s and Colitis in the ASC
Treating Crohn s and Colitis in the ASC Kimberly M Persley, MD Texas Digestive Disease consultants TASC Meeting Outline IBD 101 Diagnosis Treatment Burden of Disease Role of ASC Inflammatory Bowel Disease
More informationA Case of Crohn s Disease with Mesalazine Allergy that was Difficult to Differentiate from Comorbid Ulcerative Colitis
doi: 10.2169/internalmedicine.1607-18 http://internmed.jp CASE REPORT A Case of Crohn s Disease with Mesalazine Allergy that was Difficult to Differentiate from Comorbid Ulcerative Colitis Rumiko Tsuboi,
More informationgranulomas in inflammatory bowel disease
1484 JClinPathol 1997;5O: 148-152 Departments of Pathology and Gastroenterology, Royal Infirmary, Glasgow G31 2ER Correspondence to: Professor F D Lee, Department of Pathology, Glasgow Royal Infirmary,
More informationOncologist-induced Disease of the GI tract: New Developments
Oncologist-induced Disease of the GI tract: New Developments Jeffrey D Goldsmith, MD Children s Hospital Boston, Beth Israel Deaconess Medical Center, Harvard Medical School Boston, MA Everyone s on drugs
More informationPouchitis and Cuffitis A bloody mess. Sze-Lin Peng Colorectal Surgeon Counties Manukau District Health Board
Pouchitis and Cuffitis A bloody mess Sze-Lin Peng Colorectal Surgeon Counties Manukau District Health Board Ileal-pouch anal anastomosis https://www.pennmedicine.org/for-health-care-professionals/for-physicians/physician-education-and-resources/clinicalbriefings/2018/february/total-proctocolectomy-with-jpouch-reconstruction-for-ulcerative-colitis
More informationTerumitsu; Nagayasu, Takeshi
NAOSITE: Nagasaki University's Ac Title Author(s) Citation A rare case of segmental ulcerative Tominaga, Tetsuro; Nonaka, Takashi; Shuichi; Kunizaki, Masaki; Sumida, Terumitsu; Nagayasu, Takeshi Acta medica
More informationThe role of Surgery and Stomas in IBD
The role of Surgery and Stomas in IBD When do I need it? Can I avoid it? How do I live with it? Kyle G. Cologne, MD Assistant Professor of Surgery USC Division of Colorectal Surgery Topics Surgical Differences
More informationSimple objective criteria for diagnosis of causes of
5808 JClin Pathol 1997;50:580-585 Simple objective criteria for diagnosis of causes of acute diarrhoea on rectal biopsy Division of Pathology, Queen's Medical Centre, Nottingham, UK D Jenkins Department
More informationChromoendoscopy and Endomicroscopy for detecting colonic dysplasia
Chromoendoscopy and Endomicroscopy for detecting colonic dysplasia Ralf Kiesslich I. Medical Department Johannes Gutenberg University Mainz, Germany Cumulative cancer risk in ulcerative colitis 0.5-1.0%
More informationMimics of Inflammatory Bowel Disease. Dr Catriona McKenzie Royal Prince Alfred Hospital, Camperdown
Mimics of Inflammatory Bowel Disease Dr Catriona McKenzie Royal Prince Alfred Hospital, Camperdown Mimics of IBD: Overview Infections Drugs Autoimmune Other Infections Diagnostic Histopathology, 2015 Case
More informationMucosal healing: does it really matter?
Oxford Inflammatory Bowel Disease MasterClass Mucosal healing: does it really matter? Professor Jean-Frédéric Colombel, New York, USA Oxford Inflammatory Bowel Disease MasterClass Mucosal healing: does
More informationINFLAMMATORY BOWEL DISEASE
National University Faculty of Medicine INFLAMMATORY BOWEL DISEASE Gehan M. Osman, MD. MBBS Pediatrician Jaffar Ibn Auf Specialized Hospital EDUCATIONAL OBJECTIVES Definitions and spectrum of (IBD) Epidemiology
More informationSegmental colonoscopic biopsies in the differentiation of ileocolic tuberculosis from Crohn s disease
Blackwell Science, LtdOxford, UKJGHJournal of Gastroenterology and Hepatology0815-93192005 Blackwell Publishing Asia Pty LtdMay 2005205688696Original ArticleSegmental biopsies in and Crohn s diseaseab
More informationMicroRNA expression patterns in indeterminate inflammatory bowel disease
148 & 2013 USCAP, Inc All rights reserved 0893-3952/13 $32.00 MicroRNA expression patterns in indeterminate inflammatory bowel disease Jingmei Lin 1, Qi Cao 2, Jianjun Zhang 3, Yong Li 2, Bo Shen 4, Zijin
More informationIATROGENIC AND DRUG INDUCED PATHOLOGY IN THE SMALL INTESTINE. Claude Cuvelier N. Goormaghtigh Institute of Pathology
IATROGENIC AND DRUG INDUCED PATHOLOGY IN THE SMALL INTESTINE Claude Cuvelier N. Goormaghtigh Institute of Pathology Content Iatrogenic pathology Radiation Chemotherapy Graft-Versus-Host disease Changes
More informationSupplemental Digital Content 1. Endoscopic and histolological findings in INR and FR study subjects
Supplemental Digital Content 1. Endoscopic and histolological findings in INR and FR study subjects Patient Group Macroscopic examination Ileum Histology Colon/rectum Histology 1 INR Normal Acute and chronic
More informationChapter 12: Training in Pathology. DDSEP Chapter 13: Question 19
DDSEP Chapter 13: Question 19 A 70 year-old male with a history of celiac disease diagnosed in his forties reports abdominal pain, dark stools, and 20-pound weight loss. He reports complete compliance
More informationCrohn s Disease. Resident Lecture 1/17/19
Crohn s Disease Resident Lecture 1/17/19 Objectives Features/Classification of Crohn s Disease Medical Treatment Surgical Indications Surgical Considerations 2 Case 25 yo F presents to your office with
More informationHDF Case CRYPTOSPORIDIOSE
HDF Case 986949 CRYPTOSPORIDIOSE 45 yo male with severe diarrhea. Known HIV positive. Endoscopic biopsy of duodenum, the colon and ileum. EXUDATIVE CHANGES GRANULAR BASOPHILIC BODIES Colonic biopsy shows
More informationGastritis (and gastropathy) Dr Ian Brown Envoi Pathology Brisbane, Australia
Gastritis (and gastropathy) Dr Ian Brown Envoi Pathology Brisbane, Australia ianbrown@envoi.com.au Topics for discussion Classification of gastritis Minimal diagnostic criteria for gastritis H.pylori negative
More informationDiagnostic difficulty arising from rectal recovery
J Clin Pathol 1996;49:319-323 319 Cellular Pathology, Northwick Park and St Mark's NHS Trust, Harrow T S Levine A B Price Gastroenterology S Mitchell Histopathology, Heraklion University General Hospital,
More informationEndoscopic Diagnosis and Differentiation of Inflammatory Bowel Disease
REVIEW Clin Endosc 2016;49:370-375 http://dx.doi.org/10.5946/ce.2016.090 Print ISSN 2234-2400 On-line ISSN 2234-2443 Open Access Endoscopic Diagnosis and Differentiation of Inflammatory Bowel Disease Ji
More informationINVESTIGATIONS OF GASTROINTESTINAL DISEAS
INVESTIGATIONS OF GASTROINTESTINAL DISEAS Lecture 1 and 2 دز اسماعيل داود فرع الطب كلية طب الموصل Radiological tests of structure (imaging) Plain X-ray: May shows soft tissue outlines like liver, spleen,
More informationGastrointestinal Disorders. Disorders of the Esophagus 3/7/2013. Congenital Abnormalities. Achalasia. Not an easy repair. Types
Gastrointestinal Disorders Congenital Abnormalities Disorders of the Esophagus Types Stenosis Atresia Fistula Newborn aspirates while feeding. Pneumonia Not an easy repair Achalasia Lack of relaxation
More informationESIM: Winter School in Riga Case report
ESIM: Winter School in Riga 2015 Case report Imanta Ozola Zālīte Pauls Stradins Clinical University Hospital Latvia 29.01.2015. January, 2006 32 y., man 2-3 weeks fatigue fluidal stool 2 times per day
More informationIndex. Surg Clin N Am 87 (2007) Note: Page numbers of article titles are in boldface type.
Surg Clin N Am 87 (2007) 787 796 Index Note: Page numbers of article titles are in boldface type. A Abscesses in anorectal Crohn s disease, 622 intra-abdominal, in Crohn s disease, 590 591 perirectal,
More informationSmall Bowel Cases. Introduction. Introduction, Continued 12/7/2011. Lesions Found on endoscopic biopsies Just Like Signing Out
Small Bowel Cases Lesions Found on endoscopic biopsies Just Like Signing Out Introduction Small intestinal biopsies have a few special pitfalls, for example: Neuroendocrine tumors are readily mistaken
More informationA Practical Approach to Small Bowel Biopsies: All that flattens is not sprue
A Practical Approach to Small Bowel Biopsies: All that flattens is not sprue UCSF Liver and Gastrointestinal Pathology Update Sept. 4, 2009 How to Go Wrong When Evaluating Small Bowel Biopsies, Based on
More informationCrohn's disease of the duodenum
Crohn's disease of the duodenum F. WARREN NUGENT,' M. RICHMOND,2 AND S. K. PARK3 Gut, 1977, 18, 115-120 From the Department of Gastroenterology, Lahey Clinic Foundation, Boston, Massachusetts, USA SUMMARY
More informationConfocal laser endomicroscopy for the differential diagnosis of ulcerative colitis and Crohn s disease: a pilot study
Confocal laser endomicroscopy for the differential diagnosis of ulcerative colitis and Crohn s disease: a pilot study Authors Gian Eugenio Tontini 1, 2, Jonas Mudter 1, Michael Vieth 3, Raja Atreya 1,
More informationchildren Crohn s disease in MR enterography for GI Complications Microscopy Characterization Primary sclerosing cholangitis Anorectal fistulae
MR enterography for Crohn s disease in children BOAZ KARMAZYN, MD PEDIATRIC RADIOLOGY ASSOCIATE PROFESSOR Characterization Crohn disease Idiopathic chronic transmural IBD Increasing incidence Age 7/100,000
More informationMy Child Has Inflammatory Bowel Disease : Why? What now? What s next?
My Child Has Inflammatory Bowel Disease : Why? What now? What s next? George M. Zacur, M.D., M.S. Clinical Assistant Professor Department of Pediatrics and Communicable Diseases Division of Gastroenterology
More informationGastroenterology Tutorial
Gastroenterology Tutorial Gastritis Poorly defined term that refers to inflammation of the stomach. Infection with H. pylori is the most common cause of gastritis. Most patients remain asymptomatic Some
More informationCT Evaluation of Bowel Wall Thickening. Dr: Adel El Badrawy; M.D. Lecturer of Radio Diagnosis Faculty of Medicine Mansoura University.
CT Evaluation of Bowel Wall Thickening By Dr: Adel El Badrawy; M.D. Lecturer of Radio Diagnosis Faculty of Medicine Mansoura University. The CT findings of bowel wall thickening includes 1 Degree of thickening.
More informationTreatment of Inflammatory Bowel Disease. Michael Weiss MD, FACG
Treatment of Inflammatory Bowel Disease Michael Weiss MD, FACG What is IBD? IBD is an immune-mediated chronic intestinal disorder, characterized by chronic or relapsing inflammation within the GI tract.
More informationTHE HISTOLOGICAL DIFFERENTIATION OF TUBERCULOSIS FROM CROHN'S DISEASE IN MUCOSAL BIOPSIES FROM THE UPPER GASTROINTESTINAL TRACT WITH GRANULOMATOUS
THE HISTOLOGICAL DIFFERENTIATION OF TUBERCULOSIS FROM CROHN'S DISEASE IN MUCOSAL BIOPSIES FROM THE UPPER GASTROINTESTINAL TRACT WITH GRANULOMATOUS INFLAMMATION A Dissertation submitted in part fulfilment
More informationEuropean evidence based consensus on the diagnosis and management of Crohn s disease: definitions and diagnosis
i1 European evidence based consensus on the diagnosis and management of Crohn s disease: definitions and diagnosis E F Stange, S P L Travis, S Vermeire, C Beglinger, L Kupcinskas, K Geboes, A Barakauskiene,
More informationProctocolitis and Crohn's disease of the colon:
and of the colon: a comparison of the clinical course J. E. LENNARD-JONES, JEAN K. RITCHIE, AND W. J. ZOHRAB From St Mark's Hospital, London Gut, 1976, 17, 477-482 SUMMARY This study suggests that proctocolitis
More informationUnexpected Findings at Endoscopy
The Endoscopic Incidentaloma: What to Tell Your Patient t with Unexpected Endoscopic Findings: Gastric Intestinal Metaplasia, Silent Ileitis, Carcinoid David Greenwald, MD Montefiore Medical Center Albert
More informationOesophagus and Stomach update dysplasia and early cancer
Oesophagus and Stomach update dysplasia and early cancer Dr Tim Bracey STR teaching 13/4/16 Please check pathkids.com for previous talks One of the biggest units in the country (100 major resections per
More informationSurgery and Stomas in IBD When do I need it? Can I avoid it? How do I live with it?
Surgery and Stomas in IBD When do I need it? Can I avoid it? How do I live with it? Kyle G. Cologne, MD Assistant Professor of Surgery USC Division of Colorectal Surgery Topics Surgical Differences between
More informationObserver variation and discriminatory value of biopsy features in inflammatory bowel disease
Gut 1994; 35: 961-968 Observer variation and discriminatory value of biopsy features in inflammatory bowel disease 961 Departments of Gastroenterology and Pathology, Mayday University Hospital, Croydon
More informationFujiya M, Saitoh Y, Watari J, Moriichi K, Kohgo Y.
Digestive Endoscopy (2007) 19(s1):S145-S149. Auto-Fluorescence Imaging is useful to assess the activity of ulcerative colitis Fujiya M, Saitoh Y, Watari J, Moriichi K, Kohgo Y. Auto-Fluorescence Imaging
More informationNON INVASIVE MONITORING OF MUCOSAL HEALING IN IBD. THE ROLE OF BOWEL ULTRASOUND. Fabrizio Parente
NON INVASIVE MONITORING OF MUCOSAL HEALING IN IBD. THE ROLE OF BOWEL ULTRASOUND Fabrizio Parente Gastrointestinal Unit, A.Manzoni Hospital, Lecco & L.Sacco School of Medicine,University of Milan - Italy
More informationPathology and Diagnosis of Inflammatory Bowel Disease (IBD)
Inflammatory Bowel Disease Pathology and Diagnosis of Inflammatory Bowel Disease (IBD) JMAJ 45(2): 45 54, 2002 Takashi SHIMOYAMA Director, Department of Gastroenterology, Hyogo College of Medicine Abstract:
More informationNutritional Management in Enterocutaneous fistula Dr Deepak Govil
Nutritional Management in Enterocutaneous fistula Dr Deepak Govil MS, PhD (GI Surgery) Senior Consultant Surgical Gastroenterology Indraprastha Apollo Hospital New Delhi What is enterocutaneous fistula
More informationGastric Polyps. Bible class
Gastric Polyps Bible class 29.08.2018 Starting my training in gastroenterology, some decades ago, my first chief always told me that colonoscopy may seem technically more challenging but gastroscopy has
More informationCan We Predict the Natural History of Ulcerative Colitis? Edward V Loftus, Jr, MD Professor of Medicine Mayo Clinic Rochester, Minnesota, USA
Can We Predict the Natural History of Ulcerative Colitis? Edward V Loftus, Jr, MD Professor of Medicine Mayo Clinic Rochester, Minnesota, USA Endpoints Overview Hospitalization Surgery Colorectal cancer
More informationThe Valuable Role of Endoscopy in Inflammatory Bowel Disease
The Valuable Role of Endoscopy in Inflammatory Bowel Disease The Harvard community has made this article openly available. Please share how this access benefits you. Your story matters. Citation Published
More informationDysplasia 4/19/2017. How do I practice Chromoendoscopy for Surveillance of Colitis? SCENIC: Polypoid Dysplasia in UC. Background
SCENIC: Polypoid in UC Definition How do I practice for Surveillance of Colitis? Themos Dassopoulos, M.D. Director, BSW Center for IBD Themistocles.Dassopoulos@BSWHealth.org Tel: 469-800-7189 Cell: 314-686-2623
More information[OIs], 11 surgery, 12 endoscopy, 13 pathology, 14 anaemia, 15 reproduction and pregnancy, 16 and paediatric UC. 17
Journal of Crohn's and Colitis, 2017, 649 670 doi:10.1093/ecco-jcc/jjx008 Advance Access publication February 2, 2017 ECCO Guideline/Consensus Paper ECCO Guideline/Consensus Paper Third European Evidence-based
More informationThe Role of Ultrasound in the Assessment of Inflammatory Bowel Disease
The Role of Ultrasound in the Assessment of Inflammatory Bowel Disease Dr. Richard A. Beable Consultant Gastrointestinal Radiologist Queen Alexandra Hospital Portsmouth Hospitals NHS Trust Topics for Discussion
More informationPaneth cell metaplasia in newly diagnosed inflammatory bowel disease in children
Simmonds et al. BMC Gastroenterology 2014, 14:93 RESEARCH ARTICLE Open Access Paneth cell metaplasia in newly diagnosed inflammatory bowel disease in children Naomi Simmonds 1, Mark Furman 2, Evi Karanika
More information