Article

Diagnosis and treatment of indeterminate colitis.

Maxine and Jack Zarrow Professor Division of Gastroenterology and Hepatology Mayo Clinic Rochester, Minnesota.
Gastroenterology and Hepatology 12/2011; 7(12):826-8.
Source: PubMed
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    ABSTRACT: The precise diagnosis of colitis cannot always be established with the available diagnostic tools. The subgroup of patients with an uncertain diagnosis has been classified as "indeterminate colitis" (IC). The definition of "indeterminate," however, has changed over the years. Originally, IC was proposed by pathologists for colectomy specimens, usually from patients operated on for severe colitis, showing overlapping features of ulcerative colitis (UC) and Crohn's disease (CD). Later, the same terminology was used for patients showing no clear clinical, endoscopic, histologic, and other features allowing a diagnosis of either UC or CD. Therefore, it is difficult to compare different studies. An International Organization of Inflammatory Bowel Diseases (IOIBD) working party confirmed 1) the ambiguous nature of the term, and 2) proposes an updated classification for the category of patients with an unclear diagnosis. According to this, the term IBD unclassified (IBDU) is confirmed, as suggested by the Montreal Working Party 2005 for patients with clinically chronic colitis, that clearly have IBD but when definitive features of CD or UC are absent. In resected specimens the term "colitis of uncertain type or etiology" (CUTE) is preferred. It is accepted that most of the time this may have a prefix, such as severe, chronic. The classification of IBD varies when based only on biopsies rather than on a colectomy specimen. The vast majority of these have severe colitis. For those that cannot bear to abandon the highly ambiguous term IC, if it is used at all, this is where it can be used parenthetically.
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    ABSTRACT: The term indeterminate colitis is imprecise and without a generally accepted definition. Nevertheless, it is a term that is commonly used by gastroenterologists, pathologists and surgeons. To offer an opinion supported by published data, about the appropriate use of the term indeterminate colitis by addressing a series of questions. A PubMed database search was performed using the keywords, 'colitis' and 'inflammatory bowel disease' each combined individually with the following adjectives: 'indeterminate', 'unclassified', 'undefined', 'undiagnosed' and 'non-specific'. There is no generally accepted definition of indeterminate colitis. All current applications of the term rely on exclusionary criteria and there is no confirmatory diagnostic test. Nevertheless, the diagnosis of indeterminate colitis appears to be durable in a subgroup of patients, suggesting that this group represents a unique phenotype. Indeterminate colitis has expanded from a strictly defined, postcolectomy pathological diagnosis to become, in addition, a clinical diagnosis without generally accepted criteria. A diagnosis of indeterminate colitis should be qualified with descriptors for the diagnostic criteria applied.
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