Indeterminate colitis: A significant subgroup of pediatric IBD

Carvalho, Ryan; Abadom, Vivian; Dilworth, H. P.; Thompson, Richard E.; Oliva-Hemker, Maria; Cuffari, Carmen

doi:10.1097/01.mib.0000215093.62245.b9

Cited by 119 publications

(45 citation statements)

References 27 publications

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“…Children with IC/IBDU have an early age of disease onset, which rapidly progresses to pancolitis (Carvalho et al, 2006). For adult patients, however, the debates around the term 'IC/IBDU' have been never-ending.…”

Section: Discussionmentioning

confidence: 99%

Inflammatory bowel disease unclassified

Zhou

Chen

et al. 2011

J. Zhejiang Univ. Sci. B

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Abstract:Objective: Inflammatory bowel diseases (IBDs) are idiopathic, chronic, and inflammatory intestinal disorders. The two main types, ulcerative colitis (UC) and Crohn's disease (CD), sometimes mimic each other and are not readily distinguishable. The purpose of this study was to present a series of hospitalized cases, which could not initially be classified as a subtype of IBD, and to try to note roles of the terms indeterminate colitis (IC) and inflammatory bowel disease unclassified (IBDU) when such a dilemma arises. Methods: Medical records of 477 patients hospitalized due to IBD, during the period of January 2002 to April 2009, were retrospectively studied in the present paper. All available previous biopsies from endoscopies of these patients were reanalyzed. Results: Twenty-seven of 477 IBD patients (5.7%) had been initially diagnosed as having IBDU. Of them, 23 received colonoscopy and histological examinations in our hospital. A total of 90% (9/10) and 66.7% (4/6) of patients, respectively, had a positive finding via wireless capsule endoscopy (CE) and double-balloon enteroscopy (DBE). The barium-swallow or small bowel follow-through (SBFT) was performed on 11 patients. Positive changes were observed under computer tomographic (CT) scanning in 89.5% (17/19) of patients. Reasonable treatment strategies were employed for all patients. Conclusions: Our data indicate that IBDU accounts for 5.7% of initial diagnoses of IBD. 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 parenthetically.

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Section: Discussionmentioning

confidence: 99%

Inflammatory bowel disease unclassified

Zhou

Chen

et al. 2011

J. Zhejiang Univ. Sci. B

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“…Furthermore, in cases (that seems to have a higher prevalence than in adults [22]) in which the histological diagnosis is doubtful between UC and CD, with the possibility of a diagnosis of indeterminate colitis [23, 24], the association of histology and serological tests could contribute to a precise diagnosis of UC or CD.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Value of Serological Assays in Pediatric Inflammatory Bowel Disorders

Mainardi

Villanacci²,

Bassotti

et al. 2007

Digestion

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Background: Pediatric studies reported that the combined use of the anti-neutrophil cytoplasm autoantibodies (ANCA) and the anti-Saccharomyces cerevisiae mannan antibodies (ASCA) may be a specific useful noninvasive test in the diagnosis of inflammatory bowel diseases (IBD). Aims: To evaluate the diagnostic accuracy of ANCA and ASCA in children with suspected IBD, and to see whether different commercially available assays (indirect immunofluorescence vs. ELISA) agree well enough in terms of analytical performance. Patients and Methods: Sixty-nine children (30 males, 39 females, age range 2–18 years) with suspicion of IBD entered the study. Before colonoscopy, a blood sample was also drawn to assess ASCA and ANCA. Results: A diagnosis of IBD was established in 47 patients; the remainder had infective or other causes of colitis. For ulcerative colitis, the association ASCA–/ANCA+ had 70% sensitivity and 86% specificity, with a positive predictive value of 82%. The association ASCA+/ANCA– had 86% sensitivity and 93% specificity for Crohn’s disease, with a positive predictive value of 75%. Conclusion: Although more experience is needed to state the diagnostic power of serologic assay, determination of ANCA and ASCA in IBD children may help both in distinguish these conditions from other entitiesand ulcerative colitis from Crohn’s disease, particularly in doubtful cases.

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“…In up to 10 % of adults with IBD involving only the colon, it is not possible to distinguish Crohn's disease from ulcerative colitis (Section 4), but this increases to up to 30 % in children [120]. In the most recent study [112], 5 out of 7 children had their diagnosis changed from ulcerative colitis or IBDU to Crohn's disease on the basis of SBCE findings.…”

Section: Indications For Sbce In Paediatric Patientsmentioning

confidence: 99%