Indeterminate colitis

Department of Laboratory Medicine and Pathobiology, University of Toronto, and Department of Pathology, University Health Network, Toronto, Ontario, Canada, M5G 2C4.
Journal of Clinical Pathology (Impact Factor: 2.92). 01/2005; 57(12):1233-44. DOI: 10.1136/jcp.2003.015214
Source: PubMed


Indeterminate colitis (IC) originally referred to those 10-15% of cases of inflammatory bowel disease (IBD) in which there was difficulty distinguishing between ulcerative colitis (UC) and Crohn's disease (CD) in the colectomy specimen. However, IC is increasingly used when a definitive diagnosis of UC or CD cannot be made at colonoscopy, in colonic biopsies or at colectomy. The diagnostic difficulties may explain the variably reported prevalence of IC. Clinically, most patients with IC evolve to a definite diagnosis of UC or CD on follow up. The role of ancillary tests in the distinction of UC from CD is reviewed. The low sensitivity of serological markers limits their usefulness. Other tests include upper endoscopy and magnetic resonance imaging. The definition of IC may not be a purely histological one derived from resected specimens, but rather a clinicopathological one. This review offers some personal observations and viewpoints, and proposes an approach to some of the relatively more esoteric combinations of findings.

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    • "interleukin-1 and interleukin-6, which play primary roles in mediating IBD (Guindi and Riddell, 2004). Many genetic, environmental, and microbiological factors may influence the development of IBD, but they are still not well defined, and therefore, there is no effective therapy. "
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    ABSTRACT: The nociceptin receptors (NOP) are expressed in the gastrointestinal (GI) tract on muscle cell membranes and neurons, as well as the immune cells that infiltrate the mucosa. The involvement of NOP in the pathophysiology of GI inflammation has been suggested, but due to the lack of selective NOP agonists never fully elucidated. Our aim was to characterize the anti-inflammatory and antinociceptive effect of the NOP agonist, SCH 221510, as a potential therapeutic strategy in the treatment of inflammatory bowel diseases (IBD). The anti-inflammatory action of SCH 221510 was determined after intraperitoneal (i.p.), oral (p.o.) and intracolonic (i.c.) administration of SCH 221510 (0.1-3 mg kg-1, once or twice daily) in TNBS-treated mice. Antinociceptive action of SCH 221510 was evaluated in the mouse model of mustard oil (MO)-induced abdominal pain. Relative NOP mRNA expression was assessed in IBD patients using real-time RT-PCR. We found that the expression of NOP mRNA was significantly decreased in IBD patients. The i.p. (0.1 and 1.0 mg kg-1, twice daily) and p.o. (3 mg kg-1, twice daily) administration of SCH 221510 attenuated TNBS colitis in mice. This effect was blocked by a selective NOP antagonist (J-113397). The i.c. injections of SCH 221510 did not improve colitis in mice. The anti-nociceptive effect of SCH 221510 was observed after p.o. administration of SCH 221510 in MO-induced pain test in mice with acute colitis. Our results show a potent anti-inflammatory and antinociceptive effect upon selective activation of NOP receptors and suggest that NOP agonist, SCH 221510, is a promising drug candidate for future treatment of IBD.
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    • "There is a low but persistent incidence of diagnosis change in patients from ulcerative colitis to Crohn's disease or the reverse (Myren et al. 1988) illustrating that clinical phenotype may change over time in individual patients. In addition, approximately 10% of patients presenting with symptoms of IBD may have indeterminate features that preclude an initial diagnosis of either ulcerative colitis or Crohn's disease (Guindi and Riddell 2004). This diagnostic uncertainty primarily arises from the lack of a specific test that can differentiate ulcerative colitis from Crohn's disease resulting in heavy reliance on clinical phenotype which can be heterogeneous. "
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    ABSTRACT: Animal models of human disease are a critical tool in both basic research and drug development. The results of preclinical efficacy studies often inform progression of therapeutic candidates through the drug development pipeline; however, the extent to which results in inflammatory bowel disease (IBD) models predict human drug response is an ongoing concern. This review discusses how murine models are currently being used in IBD research. We focus on the considerations and caveats for commonly used models in preclinical efficacy studies and discuss the value of models that utilize specific pathogenic pathways of interest rather than model all aspects of human disease.
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    • "Based on clinical, radiological, endoscopic and histological characteristics, is classified as: Crohn's disease (CD), ulcerative colitis (UC) and Indeterminate Colitis (IC). The inclusion of this third category is the fact that 10% to 15% of patients did not have specific macro and microscopically well defined [1] [2]. "

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