Inflammatory bowel disease unclassified

Objective:Inflammatory bowel diseases (IBDs) are idiopathic,chronic,and inflammatory intestinal disorders.The two main types,ulcerative colitis (UC) and Crohn's disease (CD),sometimes mimic each other and are not readily distinguishable.The purpose of this study was to present a series of hospitalized cases,which could not initially be classified as a subtype of IBD,and to try to note roles of the terms indeterminate colitis (IC) and inflammatory bowel disease unclassified (IBDU) when such a dilemma arises.Methods:Medical records of 477 patients hospitalized due to IBD,during the period of January 2002 to April 2009,were retrospectively studied in the present paper.All available previous biopsies from endoscopies of these patients were reanalyzed.Results:Twenty-seven of 477 IBD patients (5.7%) had been initially diagnosed as having IBDU.Of them,23 received colonoscopy and histological examinations in our hospital.A total of 90% (9/10) and 66.7% (4/6) of patients,respectively,had a positive finding via wireless capsule endoscopy (CE) and double-balloon enteroscopy (DBE).The barium-swallow or small bowel follow-through (SBFT) was performed on 11 patients.Positive changes were observed under computer tomographic (CT) scanning in 89.5% (17/19) of patients.Reasonable treatment strategies were employed for all patients.Conclusions:Our data indicate that IBDU accounts for 5.7% of initial diagnoses of IBD.The definition of IBDU is valuable in clinical practice.For those who had no clear clinical,endoscopic,histological,or other features affording a diagnosis of either UC or CD,IBDU could be used parenthetically.

Essential role of small bowel capsule endoscopy in reclassification of colonic inflammatory bowel disease type unclassified

AIM To evaluate the role of small bowel capsule endoscopy(SBCE) on the reclassification of colonic inflammatory bowel disease type unclassified(IBDU).METHODS We performed a multicenter, retrospective study including patients with IBDU undergoing SBCE, between 2002 and 2014. SBCE studies were reviewed and the inflammatory activity was evaluated by determining the Lewis score(LS). Inflammatory activity was considered significant and consistent with Crohn's disease(CD) when the LS ≥ 135. The definitive diagnosis during follow-up(minimum 12 mo following SBCE) was based on the combination of clinical, analytical, imaging, endoscopic and histological elements.RESULTS Thirty-six patients were included, 21 females(58%) with mean age at diagnosis of 33 ± 13(15-64) years. The mean follow-up time after the SBCE was 52 ± 41(12-156) mo. The SBCE revealed findings consistent with significant inflammatory activity in the small bowel(LS ≥ 135) in 9 patients(25%); in all of them the diagnosis of CD was confirmed during follow-up. In 27 patients(75%), the SBCE revealed no significant inflammatory activity(LS < 135); among these patients, the diagnosis of Ulcerative Colitis(UC) was established in 16 cases(59.3%), CD in 1 case(3.7%) and 10 patients(37%) maintained a diagnosis of IBDU during follow-up. A LS ≥ 135 at SBCE had a sensitivity = 90%, specificity = 100%, positive predictive value = 100% and negative predictive value = 94% for the diagnosis of CD.CONCLUSION SBCE proved to be fundamental in the reclassification of patients with IBDU. Absence of significant inflammatory activity in the small intestine allowed exclusion of CD in 94% of cases.