A Review Of Inflammatory Bowel Disease Unclassified --Indeterminate Colitis

Abstract

The precise diagnosis of colitis cannot always be established with the available diagnostic tools. A diagnosis of Crohn's disease (CD) and ulcerative colitis (UC) is based on a mixture of clinical, histologic, endoscopic, and radiologic results. The difference between UC and CD can be difficult because of the lack of a differentiating single gold standard. Indeterminate colitis (IC) or inflammatory bowel disease unclassified (IBDU) was introduced by pathologists for the diagnosis of surgical colectomy specimens showing an overlap between the features of UC and CD. The term indeterminate colitis is more widely applied to include all cases with endoscopic, radiographic,and histologic evidence of chronic inflammatory bowel disease confined to the colon, but without fulfillment of diagnostic criteria for UC and CD. IC is generally considered to be a temporary diagnosis. Furthermore, serologic markers such as perinuclear antineutrophil cytoplasmic antibody and anti-Saccharomyces cerevisiae, which are strongly linked with UC and CD and other autoantibodies may be of value in the diagnosis. The possibility that IC could be a separate entity must be investigated and the diagnosis of IC or inflammatory bowel disease unclassified was based on macroscopic and microscopic features, serologic, radiologic, endoscopic presentation. The definition of IBDU is valuable in clinical practice for those who had no clear clinical, endoscopic, histological, or other features affording a diagnosis of either UC or CD, IBDU could be used incidentally. The abnormality in the immune system will favor the use of biologic therapy that neutralize the pro-inflammatory cytokines and use of anti-inflammatory cytokines instead of corticosteroid and immunosuppressive drugs.