Abstract
Indeterminate colitis is an exclusion diagnosis that is used for 10–15 % of patients who have had a colectomy for inflammatory bowel disease (IBD)–related colitis when there are no definite features of ulcerative colitis or Crohn’s colitis. The term is reserved for operated patients; those still not operated on and in whom the diagnosis is an uncertain are now considered to be “IBD unclassified.” The specific diagnosis given to a patient with IBD colitis depends on the clinical course and features, the endoscopic appearance, and to a large extent the microscopic findings, though it is evident that there is room for judgment and uncertainty. Over time, many patients with an indeterminate colitis will be reconsidered and labeled with a definite diagnosis, often ulcerative colitis. With the advent of restorative proctocolectomy including a pelvic pouch, this diagnostic dilemma has become more important. Most surgeons will not recommend a pelvic pouch to a patient with a definite diagnosis of Crohn’s disease, since most studies report a higher risk of pelvic septic complications and pouch failure in these patients. However, most agree that the risk in a patient with an indeterminate colitis is considerably less, with an only a slightly increased complication rate, compared with those with an ulcerative colitis.
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References
Kent TH, Ammon RK, DenBesten L. Differentiation of ulcerative colitis and regional enteritis of colon. Arch Pathol. 1970;89(1):20–9.
Price AB. Overlap in the spectrum of non-specific inflammatory bowel disease – ‘colitis indeterminate’. J Clin Pathol. 1978;31(6):567–77.
Geboes K, Colombel JF, Greenstein A, Jewell DP, Sandborn WJ, Vatn MH, et al. Indeterminate colitis: a review of the concept – what’s in a name? Inflamm Bowel Dis. 2008;14(6):850–7.
Geboes K, Van Eyken P. Inflammatory bowel disease unclassified and indeterminate colitis: the role of the pathologist. J Clin Pathol. 2009;62(3):201–5.
Kock NG. Intra-abdominal “reservoir” in patients with permanent ileostomy. Preliminary observations on a procedure resulting in fecal “continence” in five ileostomy patients. Arch Surg. 1969;99(2):223–31.
Oresland T, Fasth S, Nordgren S, Hulten L. The clinical and functional outcome after restorative proctocolectomy. A prospective study in 100 patients. Int J Colorectal Dis. 1989;4(1):50–6.
Prenzel F, Uhlig HH. Frequency of indeterminate colitis in children and adults with IBD – a meta analysis. J Crohns Colitis. 2009;3(4):277–81.
Turner D, Travis SP, Griffiths AM, Ruemmele FM, Levine A, Benchimol EI, et al. Consensus for managing acute severe ulcerative colitis in children: a systematic review and joint statement from ECCO, ESPGHAN, and the Porto IBD Working Group of ESPGHAN. Am J Gastroenterol. 2011;106(4):574–88.
Cummings JR, Cooney RM, Clarke G, Beckly J, Geremia A, Pathan S, et al. The genetics of NOD-like receptors in Crohn’s disease. Tissue Antigens. 2010;76(1):48–56.
Parkes M. The genetics universe of Crohn’s disease and ulcerative colitis. Dig Dis. 2012;30 Suppl 1:78–81.
Doecke JD, Simms LA, Zhao ZZ, Huang N, Hanigan K, Krishnaprasad K, et al. Genetic susceptibility in IBD: overlap between ulcerative colitis and Crohn’s disease. Inflamm Bowel Dis. 2013;19(2):240–5.
Van Limbergen J, Wilson DC, Satsangi J. The genetics of Crohn’s disease. Annu Rev Genomics Hum Genet. 2009;10:89–116.
Magro F, Langner C, Driessen A, Ensari A, Geboes K, Mantzaris GJ, et al. European consensus on the histopathology of inflammatory bowel disease. J Crohns Colitis. 2013;7(10):827–51.
Tekkis PP, Heriot AG, Smith O, Smith JJ, Windsor AC, Nicholls RJ. Long-term outcomes of restorative proctocolectomy for Crohn’s disease and indeterminate colitis. Colorectal Dis. 2005;7(3):218–23.
Romano C, Famiani A, Gallizzi R, Comito D, Ferrau V, Rossi P. Indeterminate colitis: a distinctive clinical pattern of inflammatory bowel disease in children. Pediatrics. 2008;122(6):e1278–81.
Mitchell PJ, Rabau MY, Haboubi NY. Indeterminate colitis. Tech Coloproctol. 2007;11(2):91–6.
Castillo S, Ramaiah B, Blum S, Remy P. The value of serologic markers in indeterminate colitis: a prospective follow-up study. Gastroenterology. 2003;125(3):999; author reply -1000.
Tremaine WJ. Is indeterminate colitis determinable? Curr Gastroenterol Rep. 2012;14(2):162–5.
Hui T, Landers C, Vasiliauskas E, Abreu M, Dubinsky M, Papadakis KA, et al. Serologic responses in indeterminate colitis patients before ileal pouch-anal anastomosis may determine those at risk for continuous pouch inflammation. Dis Colon Rectum. 2005;48(6):1254–62.
Burakoff R. Indeterminate colitis: clinical spectrum of disease. J Clin Gastroenterol. 2004;38(5 Suppl 1):S41–3.
Oresland T, Bemelman W, Sampietro G, Spinelli A, Windsor A, Tiret E, et al. European evidence based consensus on surgery for ulcerative colitis. J Crohn’s Colitis. 2015;9(1):4–25.
Murrell ZA, Melmed GY, Ippoliti A, Vasiliauskas EA, Dubinsky M, Targan SR, et al. A prospective evaluation of the long-term outcome of ileal pouch-anal anastomosis in patients with inflammatory bowel disease-unclassified and indeterminate colitis. Dis Colon Rectum. 2009;52(5):872–8.
Yu CS, Pemberton JH, Larson D. Ileal pouch-anal anastomosis in patients with indeterminate colitis: long-term results. Dis Colon Rectum. 2000;43(11):1487–96.
Fazio VW, Kiran RP, Remzi FH, Coffey JC, Heneghan HM, Kirat HT, et al. Ileal pouch anal anastomosis: analysis of outcome and quality of life in 3,707 patients. Ann Surg. 2013;257(4):679–85.
Wolff BG. Is ileoanal the proper operation for indeterminate colitis: the case for. Inflamm Bowel Dis. 2002;8(5):362–5; discussion 8–9.
Stewenius J, Adnerhill I, Anderson H, Ekelund GR, Floren CH, Fork FT, et al. Incidence of colorectal cancer and all cause mortality in non-selected patients with ulcerative colitis and indeterminate colitis in Malmo Sweden. Int J Colorectal Dis. 1995;10(2):117–22.
Oresland T, Palmblad S, Ellstrom M, Berndtsson I, Crona N, Hulten L. Gynaecological and sexual function related to anatomical changes in the female pelvis after restorative proctocolectomy. Int J Colorectal Dis. 1994;9(2):77–81.
Olsen KO, Juul S, Bulow S, Jarvinen HJ, Bakka A, Bjork J, et al. Female fecundity before and after operation for familial adenomatous polyposis. Br J Surg. 2003;90(2):227–31.
Leijonmarck CE, Lofberg R, Ost A, Hellers G. Long-term results of ileorectal anastomosis in ulcerative colitis in Stockholm County. Dis Colon Rectum. 1990;33(3):195–200.
Andersson P, Norblad R, Soderholm JD, Myrelid P. Ileorectal anastomosis in comparison with ileal pouch anal anastomosis in reconstructive surgery for ulcerative colitis – a single institution experience. J Crohns Colitis. 2014;8(7):582–9.
Borjesson L, Lundstam U, Oresland T, Brevinge H, Hulten L. The place for colectomy and ileorectal anastomosis: a valid surgical option for ulcerative colitis? Tech Coloproctol. 2006;10(3):237–41; discussion 41.
Delaney CP, Remzi FH, Gramlich T, Dadvand B, Fazio VW. Equivalent function, quality of life and pouch survival rates after ileal pouch-anal anastomosis for indeterminate and ulcerative colitis. Ann Surg. 2002;236(1):43–8.
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Øresland, T. (2017). Indeterminate Colitis. In: Herold, A., Lehur, PA., Matzel, K., O'Connell, P. (eds) Coloproctology. European Manual of Medicine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-53210-2_16
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DOI: https://doi.org/10.1007/978-3-662-53210-2_16
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