Value of Rectosigmoidoscopy with Biopsies for Diagnosis of Inflammatory Bowel Disease in Children

Escher, Johanna C.; Ten, K.; Lichtenbelt, Klaske D.; Schornagel, I. L.; Büller, Hans A.; Derkx, Bert; Taminiau, J. A. J. M.

doi:10.1097/00054725-200201000-00003

Cited by 60 publications

(14 citation statements)

References 14 publications

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“…The diagnosis of IBD is confirmed histologically and it is certainly possible to establish this diagnosis on proctosigmoidoscopy alone. However, in a recent study of 42 children with IBD, the diagnostic accuracy of rectosigmoid biopsies was inferior to that of ileocolonoscopic biopsies [10]. These authors therefore recommended that, at initial presentation, an ileocolonoscopy with biopsies should be performed in all children suspected of having IBD.…”

Section: Discussionmentioning

confidence: 99%

Investigating painless rectal bleeding—is there scope for improvement?

Clarke

Robb

Sugarman

et al. 2005

Journal of Pediatric Surgery

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Section: Discussionmentioning

confidence: 99%

Investigating painless rectal bleeding—is there scope for improvement?

Clarke

Robb

Sugarman

et al. 2005

Journal of Pediatric Surgery

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“…As a result of the increased use of full colonoscopy there are more opportunities to observe distribution between sites than there were in the past. There is strong evidence that IBD is classified more accurately by multiple site sampling than by limited site sampling (EL1b RGA) 5 14 21 34 36 37

Distribution between sites: continuous involvement favours UC while discontinuous/segmental abnormalities favour CD (figure 3C) (EL2a RGB) 21 36.

…”

Section: Distribution Extent and Activitymentioning

confidence: 99%

“…The label ‘indeterminate colitis’ has been used for resection specimens with definite IBD in which further classification is not appropriate 3 7 65 130 131. Unfortunately, the term has caused confusion and has often been used incorrectly to mean ‘colitis, cause unknown’ or to describe a non-existent intermediate category between UC and CD 3 7 11 13 37 61 65 88 130 132. The term ‘colitis of undetermined type/etiology’ (CUTE) has also been suggested.…”

Section: Terminologymentioning

confidence: 99%

Inflammatory bowel disease biopsies: updated British Society of Gastroenterology reporting guidelines

2013

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Accurate histopathological assessment of biopsies is important for the diagnosis, subclassification, and management of chronic idiopathic inflammatory bowel disease (IBD). British Society of Gastroenterology (BSG) guidelines for the initial histopathological diagnosis of IBD were published in 1997. Changes since then include: more widespread use of full colonoscopy; greater recognition of the effects of time and treatment; improved documentation of variations in anatomical distribution; better understanding of the mimics of IBD; significant progress in clinical management; and modifications of terminology. Accordingly, an update is required. These revised guidelines aim to optimise the quality and consistency of reporting of biopsies taken for the initial diagnosis of IBD by summarising the literature and making recommendations based on the available evidence. Advice from existing clinical guidelines is also taken into account. Among the subjects discussed are: distinguishing IBD from other colitides, particularly infective colitis; subclassification of IBD (as ulcerative colitis, Crohn's disease, or IBD unclassified); the discriminant value of granulomas; aspects of disease distribution, including discontinuity in ulcerative colitis; time-related changes; differences between paediatric and adult IBD; the role of ileal and upper gastrointestinal biopsies; differential diagnoses such as diverticular colitis and diversion proctocolitis; and dysplasia. The need to correlate the histological features with clinical and endoscopic findings is emphasised. An approach to the conclusion of an IBD biopsy report based on the acronym Pattern, Activity, Interpretation, Dysplasia (PAID) is suggested. The key recommendations are listed at the end of the document.

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“…The endoscopic procedure of choice is colonoscopy with ileal intubation and not rectosigmoidoscopy [43,44] . In children, upper GI endoscopy is very important because both retrospective and prospective studies show that histology of the upper GI tract may confirm a diagnosis of CD that would otherwise have been missed in 11-29% of cases [45] .…”

Section: Pediatric CDmentioning

confidence: 99%

Inflammatory Bowel Diseases: Controversies in the Use of Diagnostic Procedures

Vucelić¹

2009

Dig Dis

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The term inflammatory bowel disease (IBD) denotes a genetically, immunologically and histopathologically heterogeneous group of inflammatory bowel disorders classified at present time as ulcerative colitis (UC), Crohn’s disease (CD) and indeterminate colitis (IC). Diagnosis of IBD is based on a non-strictly defined combination of clinical and diagnostic parameters. In order to guide the treatment, patients must be assessed by determining IBD phenotype, disease extension and distribution, extraintestinal manifestations, disease behavior, disease severity and drug responsiveness. Each element of the diagnostic process cannot be looked at alone, but has to be incorporated into general clinical assessment, bearing in mind that different phenotypes and age groups require specific diagnostic solutions. Advances in technology provided the possibility for the assessment of the entire digestive system with endoscopy leading the way. Sophisticated imaging methods made the analysis of the bowel wall with its vascularity and adjacent mesentery possible. The challenge is still the small bowel, where a combination of endoscopy and imaging methods is used. The use of imaging methods should be, among other things, guided by level of irradiation which is especially important in young patients and in patients requiring repeated investigations. Using abdominal ultrasound as a low-cost, noninvasive procedure, one has to take into account that it is very operator-dependent method. In UC, endoscopy is used for the evaluation of the extent and activity of the disease and to assess complications like stricture, dysplasia and cancer. UC is classified by the disease extent into proctitis, left-sided colitis and extensive colitis beyond the splenic flexure. Pediatric patients with UC have more extensive disease than adults with rectal sparing in up to 30% of patients. The severity of mucosal changes are reported as Baron endoscopic score. Endoscopic findings correlate well with clinical activity and are commonly incorporated into Mayo index, combination of clinical Truelove Witts index and Baron score. Complications like strictures require imaging methods as supplement to endoscopy. The incidence of CD, particularly in children and adolescents, has risen during the past decade, with children often having extensive and severe disease The nature of CD requires the use of wide array of endoscopic and imaging methods, placed properly in the diagnostic algorithms for specific disease phenotypes and complications and adapted for specific age groups. Endoscopic features of CD are very variable and can be quantified as Crohn’s Disease Endoscopic Index of Severity (CDEIS) or Simple Endoscopic Score for CD (SES-CD). Disease activity is most commonly assessed by CDAI. Perianal disease activity should be measured by PDAI due to low CDAI scores in these patients. The activity of CD in children should be assessed by the Pediatric Activity Index. IC is part of the IBD spectrum where chronic colitis cannot be defined as either UC or CD after sequential co...

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Value of Rectosigmoidoscopy with Biopsies for Diagnosis of Inflammatory Bowel Disease in Children

Abstract: Histology on biopsies from rectum and sigmoid is insufficient for a correct diagnosis of Crohn's disease or ulcerative colitis in children. At initial presentation, an ileocolonoscopy with biopsies should therefore be performed in all children.

Cited by 60 publications

References 14 publications

Investigating painless rectal bleeding—is there scope for improvement?

Investigating painless rectal bleeding—is there scope for improvement?

Inflammatory bowel disease biopsies: updated British Society of Gastroenterology reporting guidelines

Inflammatory Bowel Diseases: Controversies in the Use of Diagnostic Procedures

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