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Chapter 21 - Inflammatory Bowel Disease Diagnosis

Published online by Cambridge University Press:  06 June 2020

By
Roger M. Feakins
Edited by
Roger M. Feakins
Roger M. Feakins
Affiliation:
Royal Free London NHS Foundation Trust, London, UK
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Summary

Biopsy assessment of chronic idiopathic inflammatory bowel disease (IBD) is important for diagnosis, classification, determination of activity, documentation of anatomical extent and distribution, detection of complications, and diagnosis and grading of dysplasia. In addition, it may predict treatment response, clinical behaviour after therapy, and risk of future dysplasia. Microscopic features favouring IBD over non-IBD in biopsies include basal plasmacytosis and crypt architectural changes. Typically, ulcerative colitis (UC) extends from the rectum proximally and in a continuous fashion, while Crohn’s disease is discontinuous with intervening areas of sparing. Microscopic features that distinguish most reliably between Crohn’s disease and UC include granulomas (strongly favouring Crohn’s disease) and the distribution of architectural abnormalities/chronic inflammation between sites and within sites. However, discontinuity may also occur in UC. A caecal ‘patch’, i.e. a discontinuous area of caecal inflammation, is common in UC. Rectal sparing and other forms of discontinuity are more frequent in longstanding UC than new UC. The label IBD unclassified (IBDU) is available for difficult cases. In very early IBD (i.e., symptoms for <6 weeks), the architectural changes are often absent. IBD is common in patients with primary sclerosing cholangitis but may have unusual features. In summary, histological assessment in the light of the clinical and endoscopic findings plays an important role in optimising management of IBD.

Keywords

histologydiagnosisinflammatory bowel diseaseulcerative colitisCrohn’s diseaseinflammatory bowel disease unclassifiedindeterminate colitisbasal plasmacytosisgranuloma
Type
Chapter
Information
Non-Neoplastic Pathology of the Gastrointestinal Tract
A Practical Guide to Biopsy Diagnosis
 , pp. 325 - 356
Publisher: Cambridge University Press
Print publication year: 2020

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References

Ng, SC, Shi, HY, Hamidi, N, et al. Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. Lancet. 2018;390(10114):2769–78.Google Scholar
Feakins, RM. Inflammatory bowel disease biopsies: updated British Society of Gastroenterology reporting guidelines. J Clin Pathol. 2013;66:1005–26.Google Scholar
Zezos, P, Patsiaoura, K, Nakos, A, et al. Severe eosinophilic infiltration in colonic biopsies predicts patients with ulcerative colitis not responding to medical therapy. Colorect Dis.2014;16(12):O420–30.Google Scholar
Morgenstern, S, Brook, E, Rinawi, F, Shamir, R, Assa, A. Tissue and peripheral eosinophilia as predictors for disease outcome in children with ulcerative colitis. Dig. Liver Dis. 2017;49(2):170–4.Google Scholar
Mosli, MH, Parker, CE, Nelson, SA, et al. Histologic scoring indices for evaluation of disease activity in ulcerative colitis. Cochrane Database Syst Rev. 2017;5:CD011256.Google Scholar
Bressenot, A, Salleron, J, Bastien, C, Danese, S, Boulagnon-Rombi, C, Peyrin-Biroulet, L. Comparing histological activity indexes in UC. Gut. 2015;64(9):1412–8.Google Scholar
Christensen, B, Hanauer, SB, Erlich, J, et al. Histologic normalization occurs in ulcerative colitis and is associated with improved clinical outcomes. Clin Gastroenterol. Hepatol. 2017;10:1557–64.Google Scholar
Rutter, M, Saunders, B, Wilkinson, K, et al. Severity of inflammation is a risk factor for colorectal neoplasia in ulcerative colitis. Gastroenterology. 2004;126:451–9.Google Scholar
Stange, EF, Travis, SPL, Vermeire, S, et al. for the European Crohn’s and Colitis Organisation (ECCO). European evidence-based consensus on the diagnosis and management of ulcerative colitis: definitions and diagnosis. J Crohns Colitis. 2008;2:1–23.CrossRefGoogle ScholarPubMed
Silverberg, MS, Satsangi, J, Ahmad, T, et al. Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: Report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. Can J Gastroenterol. 2005;19(Suppl A):5–36.Google Scholar
Yantiss, RK, Farraye, FA, O’Brien, MJ, et al. Prognostic significance of superficial fissuring ulceration in patients with severe ‘indeterminate’ colitis. Am J Surg Pathol. 2006;30:165–70.Google Scholar
Stange, EF, Travis, SPL, Vermeire, S, et al. European evidence based consensus on the diagnosis and management of Crohn’s disease: definitions and diagnosis. Gut. 2006;55(Suppl 1):i1–i15.Google Scholar
Siegmund, B, Feakins, RM, Barmias, G, et al. Results of the Fifth Scientific Workshop of the ECCO (II): Pathophysiology of perianal fistulizing disease. J Crohns Colitis. 2016;10(4):377–86.Google Scholar
Soucy, G, Wang, HH, Farraye, FA, et al. Clinical and pathological analysis of colonic Crohn’s disease, including a subgroup with ulcerative colitis-like features. Mod Pathol. 2012;25(2):295–307.Google Scholar
Jones, I, Ramani, P, Spray, C, Cusick, E. How secure is the diagnosis of ulcerative colitis in children, even after colectomy? J Pediatr Gastroenterol nutr. 2018;66(1):69–72.Google Scholar
Tanaka, M, Saito, H, Fukuda, S, Sasaki, Y, Munakata, A, Kudo, H. Simple mucosal biopsy criteria differentiating among Crohn disease, ulcerative colitis, and other forms of colitis: measurement of validity. Scand J Gastroenterol. 2000;35:281–6.Google Scholar
Bentley, E, Jenkins, D, Campbell, F, Warren, B. How could pathologists improve the initial diagnosis of colitis? Evidence from an international workshop. J Clin Pathol. 2002;55:955–60.CrossRefGoogle ScholarPubMed
Escher, JC, ten, KF, Lichtenbelt, K, et al. Value of rectosigmoidoscopy with biopsies for diagnosis of inflammatory bowel disease in children. Inflamm Bowel Dis. 2002;8:16–22.Google Scholar
Seldenrijk, CA, Morson, BC, Meuwissen, SGM, Schipper, NW, Lindeman, J, Meijer, CJ. Histopathological evaluation of colonic mucosal biopsy specimens in chronic inflammatory bowel disease: diagnostic implications. Gut. 1991;32:1514–20.CrossRefGoogle ScholarPubMed
Tanaka, M, Riddell, RH, Saito, H, Soma, Y, Hidaka, H, Kudo, H. Morphologic criteria applicable to biopsy specimens for effective distinction of inflammatory bowel disease from other forms of colitis and of Crohn’s disease from ulcerative colitis. Scand J Gastroenterol. 1999;34:55–67.Google ScholarPubMed
Dejaco, C, Oesterreicher, C, Angelberger, S, et al. Diagnosing colitis: a prospective study on essential parameters for reaching a diagnosis. Endoscopy. 2003;35:1004–8.CrossRefGoogle ScholarPubMed
D’Haens, G, Geboes, K, Peeters, M, Baert, F, Ectors, N, Rutgeerts, P. Patchy cecal inflammation associated with distal ulcerative colitis: a prospective endoscopic study. Am J Gastroenterol. 1997;92:1275–9.Google Scholar
Washington, K, Greenson, JK, Montgomery, E, et al. Histopathology of ulcerative colitis in initial rectal biopsy in children. Am J Surg Pathol. 2002;26:1441–9.CrossRefGoogle ScholarPubMed
Markowitz, J, Kahn, E, Grancher, K, Hyams, J, Treem, W, Daum, F. Atypical rectosigmoid histology in children with newly diagnosed ulcerative colitis. Am J Gastroenterol. 1993;88:2034–7.Google Scholar
Kleer, CG, Appelman, HD. Ulcerative colitis: patterns of involvement in colorectal biopsies and changes with time. Am J Surg Pathol. 1998;22(8):983–9.Google Scholar
Joo, M, Odze, RD. Rectal sparing and skip lesions in ulcerative colitis: a comparative study of endoscopic and histologic findings in patients who underwent proctocolectomy. Am J Surg Pathol. 2010;34:689–96.Google Scholar
Robert, ME, Tang, L, Hao, LM, Reyes-Mugica, M. Patterns of inflammation in mucosal biopsies of ulcerative colitis: perceived differences in pediatric populations are limited to children younger than 10 years. Am J Surg Pathol. 2004;28:183–9.Google Scholar
Schumacher, G, Kollberg, B, Sandstedt, B. A prospective study of first attacks of inflammatory bowel disease and infectious colitis. Histologic course during the 1st year after presentation. Scand J Gastroenterol. 1994;29:318–32.Google Scholar
Surawicz, CM, Haggitt, RC, Husseman, M, McFarland, LV. Mucosal biopsy diagnosis of colitis: acute self-limited colitis and idiopathic inflammatory bowel disease. Gastroenterology. 1994;107(3):755–63.Google Scholar
Nostrant, TT, Kumar, NB, Appelman, HD. Histopathology differentiates acute self-limited colitis from ulcerative colitis. Gastroenterology. 1987;92(2):318–28.CrossRefGoogle ScholarPubMed
Surawicz, C, Belic, L. Rectal biopsy helps to distinguish acute self-limited colitis from idiopathic inflammatory bowel disease. Gastroenterology. 1984;86(1):104–13.Google Scholar
Allison, MC, Hamilton-Dutoit, SJ, Dhillon, AP, Pounder, RE. The value of rectal biopsy in distinguishing self-limited colitis from early inflammatory bowel disease. Q J Med. 1987;65(248):985–95.Google Scholar
Levine, DS, Haggitt, RC. Normal histology of the colon. Am J Surg Pathol. 1989;13:966–84.Google Scholar
Theodossi, A, Spiegelhalter, DJ, Jass, J, et al. Observer variation and discriminatory value of biopsy features in inflammatory bowel disease. Gut. 1994;35:961–8.Google Scholar
Jenkins, D, Balsitis, M, Gallivan, S, et al. Guidelines for the initial biopsy diagnosis of suspected chronic idiopathic inflammatory bowel disease. The British Society of Gastroenterology Initiative. J Clin Pathol. 1997;50:93–105.Google Scholar
Talbot, I, Price, A, Salto-Tellez, M. Biopsy Pathology in Colorectal Disease, 2nd ed. London: Hodder Arnold; 2006.Google Scholar
Pezhouh, MK, Cheng, E, Weinberg, AG, Park, JY. Significance of Paneth cells in histologically unremarkable rectal mucosa. Am J Surg Pathol. 2016;40(7):968–71.Google Scholar
Lee, FD. Importance of apoptosis in the histopathology of drug related lesions in the large intestine. J Clin Pathol. 1993;46(2):118–22.Google Scholar
Jenkins, D, Goodall, A, Scott, BB. Simple objective criteria for diagnosis of causes of acute diarrhoea on rectal biopsy. J Clin Pathol. 1997;50:580–5.Google Scholar
Surawicz, C. What’s the best way to differentiate infectious colitis (acute self-limited colitis) from IBD? Inflamm Bowel Dis. 2008;14(Suppl 2):S157–8.Google Scholar
Robert, ME, Skacel, M, Ullman, T, Bernstein, CN, Easley, K, Goldblum, JR. Patterns of colonic involvement at initial presentation in ulcerative colitis: a retrospective study of 46 newly diagnosed cases. Am J Clin Pathol. 2004;122(1):94–9.Google Scholar
Dundas, SA, Dutton, J, Skipworth, P. Reliability of rectal biopsy in distinguishing between chronic inflammatory bowel disease and acute self-limiting colitis. Histopathology. 1997;31(1):60–6.Google Scholar
Pierik, M, De Hertogh, G, Vermeire, S, et al. Epithelioid granulomas, pattern recognition receptors, and phenotypes of Crohn’s disease. Gut. 2005;54(2):223–7.Google Scholar
Tanaka, M, Saito, H, Kusumi, T, et al. Spatial distribution and histogenesis of colorectal Paneth cell metaplasia in idiopathic inflammatory bowel disease. J Gastroenterol Hepatol. 2001;16:1353–9.Google Scholar
Simmonds, N, Furman, M, Karanika, E, Phillips, A, Bates, AW. Paneth cell metaplasia in newly diagnosed inflammatory bowel disease in children. BMC gastroenterol. 2014;14:93.Google Scholar
Ayata, G, Ithamukkala, S, Sapp, H, et al. Prevalence and significance of inflammatory bowel disease-like morphologic features in collagenous and lymphocytic colitis. Am J Surg Pathol. 2002;26:1414–23.CrossRefGoogle ScholarPubMed
Khor, TS, Fujita, H, Nagata, K, Shimizu, M, Lauwers, GY. Biopsy interpretation of colonic biopsies when inflammatory bowel disease is excluded. J Gastroenterol. 2012;47(3):226–48.CrossRefGoogle ScholarPubMed
Le Berre, N, Heresbach, D, Kerbaol, M, et al. Histological discrimination of idiopathic inflammatory bowel disease from other types of colitis. J Clin Pathol. 1995;48(8):749–53.Google Scholar
Cross, SS, Harrison, RF. Discriminant histological features in the diagnosis of chronic idiopathic inflammatory bowel disease: analysis of a large dataset by a novel data visualisation technique. J Clin Pathol. 2002;55(1):51–7.Google Scholar
Lessells, AM, Beck, JS, Burnett, RA, et al. Observer variability in the histopathological reporting of abnormal rectal biopsy specimens. J Clin Pathol. 1994;47:48–52.Google Scholar
Geboes, K, Ectors, N, D’Haens, G, Rutgeerts, P. Is ileoscopy with biopsy worthwhile in patients presenting with symptoms of inflammatory bowel disease? Am J Gastroenterol. 1998;93(2):201–6.Google Scholar
Haskell, H, Andrews, CW Jr, Reddy, SI, et al. Pathologic features and clinical significance of ‘backwash’ ileitis in ulcerative colitis. Am J Surg Pathol. 2005;29:1472–81.Google Scholar
Morson, BC. Pathology of inflammatory diseases. Proc R Soc Med. 1970;63(Suppl):63.Google ScholarPubMed
Goldstein, N, Dulai, M. Contemporary morphologic definition of backwash ileitis in ulcerative colitis and features that distinguish it from Crohn disease. Am J Clin Pathol. 2006;126(3):365–76.Google Scholar
Brown, IS, Miller, GC, Bettington, ML, Rosty, C. Histopathological findings of extra-ileal manifestations at initial diagnosis of Crohn’s disease-related ileitis. Virchows Arch. 2016;469(5):515–22.Google Scholar
Guindi, M, Riddell, RH. Indeterminate colitis. J Clin Pathol. 2004;57:1233–44.Google Scholar
Lee, FD, Maguire, C, Obeidat, W, Russell, RI. Importance of cryptolytic lesions and pericryptal granulomas in inflammatory bowel disease. J Clin Pathol. 1997;50(2):148–52.Google Scholar
Heresbach, D, Alexandre, JL, Branger, B, et al. Frequency and significance of granulomas in a cohort of incident cases of Crohn’s disease. Gut. 2005;54:215–22.Google Scholar
Idestrom, M, Rubio, CA, Onelov, E, Henter, JI, Fagerberg, UL, Finkel, Y. Pediatric Crohn’s disease from onset to adulthood: granulomas are associated with an early need for immunomodulation. Scand J Gastroenterol. 2014;49(8):950–7.Google Scholar
Rubio, CA, Orrego, A, Nesi, G, Finkel, Y. Frequency of epithelioid granulomas in colonoscopic biopsy specimens from paediatric and adult patients with Crohn’s colitis. J Clin Pathol. 2007;60:1268–72.Google Scholar
Sun, X, Yuan, L, Li, Y, Shen, B, Xie, H, Liu, X. Association of granulomas in mesenteric lymph nodes in Crohn’s disease with younger age and transmural inflammation. J Gastroenterol Hepatol. 2017;32(8):1463–8.Google Scholar
Li, Y, Stocchi, L, Liu, X, et al. Presence of granulomas in mesenteric lymph nodes is associated with postoperative recurrence in Crohn’s disease. Inflamm Bowel Dis. 2015;21(11):2613–8.Google Scholar
Mahadeva, U, Martin, JP, Patel, NK, Price, AB. Granulomatous ulcerative colitis: a re-appraisal of the mucosal granuloma in the distinction of Crohn’s disease from ulcerative colitis. Histopathology. 2002;41(1):50–5.Google Scholar
Warren, BF, Shepherd, NA. Diversion proctocolitis. Histopathology. 1992;21(1):91–3.Google Scholar
Warren, BF, Shepherd, NA, Price, AB, Williams, GT. Importance of cryptolytic lesions and pericryptal granulomas in inflammatory bowel disease. J Clin Pathol. 1997;50(10):880–1.Google Scholar
Lin, J, Fan, R, Zhao, Z, Cummings, OW, Chen, S. Is the presence of 6 or fewer crypt apoptotic bodies sufficient for diagnosis of graft versus host disease? A decade of experience at a single institution. Am J Surg Pathol. 2013;37(4):539–47.Google Scholar
Rowan, DJ, Hartley, CP, Carrillo-Polanco, LF, Oshima, K, Hagen, CE. Diagnostic phrasing is independently correlated with the decision to treat for graft-versus-host disease: retrospective review of colon biopsies with rare apoptosis. Histopathology. 2016;69(5):802–11.Google Scholar
Turner, KO, Sinkre, RA, Neumann, WL, Genta, RM. Primary colonic eosinophilia and eosinophilic colitis in adults. Am J Surg Pathol. 2017;41(2):225–33.Google Scholar
Matsushita, T, Maruyama, R, Ishikawa, N, et al. The number and distribution of eosinophils in the adult human gastrointestinal tract: a study and comparison of racial and environmental factors. Am J Surg Pathol. 2015;39(4):521–7.Google Scholar
Pascal, RR, Gramlich, TL, Parker, KM, Gansler, TS. Geographic variations in eosinophil concentration in normal colonic mucosa. Mod Pathol. 1997;10(4):363–5.Google Scholar
Polydorides, AD, Banner, BF, Hannaway, PJ, Yantiss, RK. Evaluation of site-specific and seasonal variation in colonic mucosal eosinophils. Hum pathol. 2008;39(6):832–6.CrossRefGoogle ScholarPubMed
Casella, G, Villanacci, V, Fisogni, S, et al. Colonic left-side increase of eosinophils: a clue to drug-related colitis in adults. Aliment Pharmacol Ther. 2009;29(5):535–41.Google Scholar
Saad, AG. Normal quantity and distribution of mast cells and eosinophils in the pediatric colon. Pediatr. Dev pathol. 2011;14(4):294–300.Google Scholar
Tanaka, M, Saito, H, Kusumi, T, et al. Biopsy pathology predicts patients with ulcerative colitis subsequently requiring surgery. Scand J Gastroenterol. 2002;37(2):200–5.Google Scholar
Uppal, V, Kreiger, P, Kutsch, E. Eosinophilic gastroenteritis and colitis: a comprehensive review. Clin Rev Allergy Immunol. 2016;50(2):175–88.Google Scholar
Geboes, K, Dalle, I. Influence of treatment on morphological features of mucosal inflammation. Gut. 2002;50(Suppl 3:III):37–42.Google Scholar
Therkildsen, MH, Jensen, BN, Teglbjaerg, PS, Rasmussen, SN. The final outcome of patients presenting with their first episode of acute diarrhoea and an inflamed rectal mucosa with preserved crypt architecture: a clinicopathologic study. Scand J Gastroenterol. 1989;24:158–64.Google Scholar
Mutinga, ML, Odze, RD, Wang, HH, Hornick, JL, Farraye, FA. The clinical significance of right-sided colonic inflammation in patients with left-sided chronic ulcerative colitis. Inflamm Bowel Dis. 2004;10(3):215–9.Google Scholar
Odze, R. Diagnostic problems and advances in inflammatory bowel disease. Mod Pathol. 2003;16:347–58.Google Scholar
Kim, B, Barnett, JL, Kleer, CG, Appelman, HD. Endoscopic and histological patchiness in treated ulcerative colitis. Am J Gastroenterol. 1999;94(11):3258–62.Google Scholar
Bernstein, CN, Shanahan, F, Anton, PA, Weinstein, WM. Patchiness of mucosal inflammation in treated ulcerative colitis: a prospective study. Gastrointest Endosc. 1995;42(3):232–7.Google Scholar
Hyde, GM, Jewell, DP, Warren, BF. Histological changes associated with the use of intravenous cyclosporin in the treatment of severe ulcerative colitis may mimic dysplasia. Colorect Dis. 2002;4(6):455–8.CrossRefGoogle ScholarPubMed
Bermejo, F, Lopez-Sanroman, A, Hinojosa, J, Castro, L, Jurado, C, Gomez-Beldal, AB. Infliximab induces clinical, endoscopic and histological responses in refractory ulcerative colitis. Rev Esp Enferm Dig. 2004;96(2):94–101.Google Scholar
Mayer, L, Sandborn, WJ, Stepanov, Y, et al. Anti-IP-10 antibody (BMS-936557) for ulcerative colitis: a phase II randomised study. Gut. 2014;63(3):442–50.Google Scholar
Travis, SP, Higgins, PD, Orchard, T, et al. Review article: defining remission in ulcerative colitis. Aliment Pharmacol Ther. 2011;34(2):113–24.CrossRefGoogle ScholarPubMed
Peyrin-Biroulet, L, Ferrante, M, Magro, F, et al. Results from the 2nd Scientific Workshop of the ECCO. I: Impact of mucosal healing on the course of inflammatory bowel disease. J Crohns Colitis. 2011;5(5):477–83.Google Scholar
Riley, SA, Mani, V, Goodman, MJ, Dutt, S, Herd, ME. Microscopic activity in ulcerative colitis: what does it mean? Gut. 1991;32(2):174–8.Google Scholar
Geboes, K, Riddell, R, Ost, A, Jensfelt, B, Persson, T, Löfberg, R. A reproducible grading scale for histological assessment of inflammation in ulcerative colitis. Gut. 2000;47:404–9.Google Scholar
Gupta, RB, Harpaz, N, Itzkowitz, S, et al. Histologic inflammation is a risk factor for progression to colorectal neoplasia in ulcerative colitis: a cohort study. Gastroenterology. 2007;133(4):1099–105; quiz 340–1.Google Scholar
Marchal-Bressenot, A, Salleron, J, Boulagnon-Rombi, C, et al. Development and validation of the Nancy histological index for UC. Gut. 2017;66(1):43–9.Google Scholar
Bryant, RV, Burger, DC, Delo, J, et al. Beyond endoscopic mucosal healing in UC: histological remission better predicts corticosteroid use and hospitalisation over 6 years of follow-up. Gut. 2016;65(3):408–14.Google Scholar
North American Society for Pediatric Gastroenterology Hepatology, and Nutrition; Colitis Foundation of America, Bousvaros A, Antonioli, DA, Colletti, RB, Dubinsky, MC, et al. Differentiating ulcerative colitis from Crohn disease in children and young adults: report of a working group of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the Crohn’s and Colitis Foundation of America. J Pediatr Gastroenterol Nutr. 2007;44:653–74.Google Scholar
Shetty, S, Anjarwalla, SM, Gupta, J, et al. Focal active colitis: a prospective study of clinicopathological correlations in 90 patients. Histopathology. 2011;59(5):850–6.Google Scholar
Greenson, JK, Stern, RA, Carpenter, SL, Barnett, JL. The clinical significance of focal active colitis. Hum Pathol. 1997;28:729–33.Google Scholar
Volk, EE, Shapiro, BD, Easley, KA, Goldblum, JR. The clinical significance of a biopsy-based diagnosis of focal active colitis: a clinicopathologic study of 31 cases. Mod Pathol. 1998;11(8):789–94.Google Scholar
de Vries, AB, Janse, M, Blokzijl, H, Weersma, RK. Distinctive inflammatory bowel disease phenotype in primary sclerosing cholangitis. World J Gastroenterol. 2015;21(6):1956–71.Google Scholar
Joo, M, Abreu-e-Lima, P, Farraye, F, et al. Pathologic features of ulcerative colitis in patients with primary sclerosing cholangitis: a case-control study. Am J Surg Pathol. 2009;33(6):854–62.Google Scholar
Boonstra, K, van Erpecum, KJ, van Nieuwkerk, KM, et al. Primary sclerosing cholangitis is associated with a distinct phenotype of inflammatory bowel disease. Inflamm Bowel Dis. 2012;18(12):2270–6.Google Scholar
Schaeffer, DF, Win, LL, Hafezi-Bakhtiari, S, Cino, M, Hirschfield, GM, El-Zimaity, H. The phenotypic expression of inflammatory bowel disease in patients with primary sclerosing cholangitis differs in the distribution of colitis. Dig Dis Sci. 2013;58(9):2608–14.Google Scholar
Sinakos, E, Samuel, S, Enders, F, Loftus, EV Jr., Sandborn, WJ, Lindor, KD. Inflammatory bowel disease in primary sclerosing cholangitis: a robust yet changing relationship. Inflamm Bowel Dis. 2013;19(5):1004–9.Google Scholar
Eaton, JE, Talwalkar, JA, Lazaridis, KN, Gores, GJ, Lindor, KD. Pathogenesis of primary sclerosing cholangitis and advances in diagnosis and management. Gastroenterology. 2013;145(3):521–36.Google Scholar
Loftus, EV, Jr., Harewood, GC, Loftus, CG, et al. PSC-IBD: a unique form of inflammatory bowel disease associated with primary sclerosing cholangitis. Gut. 2005;54(1):91–6.Google Scholar
Pittman, ME, Jessurun, J, Yantiss, RK. Differentiating posttransplant inflammatory bowel disease and other colitides in renal transplant patients. Am J Surg Pathol. 2017;41(12):1666–74.Google Scholar
Tontini, GE, Mudter, J, Vieth, M, et al. Confocal laser endomicroscopy for the differential diagnosis of ulcerative colitis and Crohn’s disease: a pilot study. Endoscopy. 2015;47(5):437–43.Google Scholar
Neumann, H, Kiesslich, R. Endomicroscopy and endocytoscopy in IBD. Gastrointest Endosc Clin North Am. 2013;23(3):695–705.Google Scholar
Liu, J, Dlugosz, A, Neumann, H. Beyond white light endoscopy: the role of optical biopsy in inflammatory bowel disease. World J Gastroenterol. 2013;19(43):7544–51.Google Scholar

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