Non-IBD colitides: clinically useful histopathological clues

Abstract

Apart from inflammatory bowel diseases (IBD), there are several other form of colitis that may resemble macroscopically IBD, entering the differential diagnosis. These forms are represented by infectious colitis, ischemic colitis, pseudomembranous colitis, colitis related to diverticular disease, colitis related to mucosal prolapse, drug colitis, allergic colitis, and microscopic colitis. However, to distinguish between these forms is not always easy, and it frequently requires a strict interrelationship between the pathologist and the gastroenterologist. Here we discuss the more frequent forms of non-inflammatory bowel diseases colitides, trying to give useful hints for helping the clinician to better understand the extent to which the pathologist is called to give a definitive response in the differential diagnosis of these entities.

Severe spruelike enteropathy due to olmesartan

“…Besides, physicians should be aware that normal colonoscopic findings in patients with unexplained diarrhea and negative serologic tests and stool cultures must not automatically led to a diagnosis of irritable bowel syndrome; indeed, there is mounting evidence that in such patients the presence of drug colitides must be carefully excluded by multiple ileal and colonic sampling and careful evaluation by expert gastrointestinal pathologists (16)(17)(18).…”

“…Blood chemistry revealed hemoglobin 13 g/ dL (n.v. [13][14][15][16][17], serum potassium 2.3 mEq/L (n.v. 3.5-5-5), calcium 6 mg/dL (n.v. 8.5-10.7), magnesium 0.8 mg/ dL (n.v. 1.5-2.6), phosphorus 2.4 mg/dL (n.v. 2.5-5), albumin 2.9 g/dL (n.v. 3.5-5.5), prealbumin 15.5 mg/dL (n.v. 20-40), total protein 4.9 g/dL (n.v. 6.2-8.5), B12 vitamin 103 pg/mL (n.v. 180-914), folic acid 2.7 ng/mL (n.v. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Abdominal ultrasound scans revealed mildly dilated small bowel loops in the epigastric area, mild hepatomegaly with steatosis, and biliary sludge.…”

Ischemic colitis associated with hormonal contraceptive treatment delivered via vaginal ring

“…Other segments of the colon can also be affected (3). Clinical diagnosis is difficult and a biopsy is normally required (9). This can be done safely usually unless the mucosa has a black or dusky color in which case the risk of perforation is high.…”

Eosinophilia – associated basal plasmacytosis: an early and sensitive histologic feature of inflammatory bowel disease

“…The histologic diagnosis of inflammatory bowel diseases (IBD) is often challenging, especially in the first phase of the disease, since the microscopic pattern of IBD in colonic biopsies is poorly specific and often insufficient for a definite differential diagnosis with non IBD colitides .…”