Abstract
The term indeterminate colitis has been used to describe cases of inflammatory bowel disease that cannot be classified as ulcerative colitis or Crohn’s disease. However, this term has suffered varying definitions, which in addition to numerous difficulties in diagnosing inflammatory bowel disease has led to much confusion. The term indeterminate colitis should only be used in cases where a colectomy has been performed and the overlap** features of Crohn’s disease and ulcerative colitis do not allow a definitive diagnosis. Over time the majority of patients remain with a diagnosis of indeterminate colitis, or show symptoms similar to ulcerative colitis. Ileal pouch-anal anastomosis surgery can be performed in such patients, with outcomes of pouch failure and functional outcome that are similar to those in patients with ulcerative colitis but with increased risk of postoperative pouch complications. This review addresses the definition of indeterminate colitis, its pathology, natural history, and outcomes of restorative proctocolectomy.
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References
Price AB (1978) Overlap in the spectrum of non-specific inflammatory bowel disease — ‘colitis indeterminate’ J Clin Pathol 31:567–577
Lee KS, Medline A, Shockey S (1979) Indeterminate colitis in the spectrum of inflammatory bowel disease. Arch Pathol Lab Med 103:173–176
Farmer M, Petras RE, Hunt LE, Janosky JE, Galanduik S (2000) The importance of diagnostic accuracy in colonic inflammatory bowel disease. Am J Gastroenterol 95:3184–3188
Yu CS, Pemberton JH, Larson D (2000) Ileal pouch-anal anastomosis in patients with indeterminate colitis. Long term results. Dis Colon Rectum 43:1487–1496
Koltun WA, Schoetz DJ Jr, Roberts PL, Murray JJ, Coller JA, Veidenheimer MC (1991) Indeterminate colitis predisposes to perineal complications after ileal pouch-anal anastomosis. Dis Colon Rectum 34:857–860
Meucci G, Bortoli A, Riccioli FA et al (1999) Frequency and clinical evolution of indeterminate colitis: a retrospective multi-centre study in northern Italy. Eur J Gastroenterol Hepatol 11:909–913
Satsangi J, Silverberg MS, Vermeire S, Colombel JF (2006) The Montreal classification of inflammatory bowel disease: controversies, consensus and implications. Gut 55:749–753
Brown CJ, MacLean AR, Cohen Z, MacRae HM, O’Connor BI, McLeod RS (2005) Crohn’s disease and indeterminate colitis and the ileal pouch-anal anastomosis: outcomes and patterns of failure. Dis Colon Rectum 48:1542–1549
Marcello PW, Schoetz DJ, Roberts PL et al (1997) Evolutionary changes in the pathologic diagnosis after the ileoanal pouch procedure. Dis Colon Rectum 40:263–269
Rudolph WG, Uthoff SMS, McAuliffe TL, Goode ET, Petras RE, Galandiuk S (2002) Indeterminate colitis: the real story. Dis Colon Rectum 45:1528–1534
Delaney CP, Remzi FH, Gramlich T, Dadvand B, Fazio VW (2002) Equivalent function, quality of life and pouch survival rates after ileal pouch-anal anastomosis for indeterminate colitis and ulcerative colitis. Ann Surg 236:43–48
Swan NC, Geoghegan JG, O’Donoghue DP, Hyland JMP, Sheahan K (1998) Fulminant colitis in inflammatory bowel disease. Detailed pathologic and clinical analysis. Dis Colon Rectum 41:1511–1515
Odze RD (2003) Diagnostic problems and advances in inflammatory bowel disease. Mod Pathol 16:347–358
D’Haens G, Geboes K, Peeters M, Baert F, Ectors N, Rutgeerts P (1997) Patchy caecal inflammation associated with distal ulcerative colitis: a prospective endoscopic study. Am J Gastroenterol 92:1275–1279
Mutinga ML, Odze RD, Wang HH, Hornick JL, Farraye FA (2004) The clinical significance of right-sided colonic inflammation in patients with left sided chronic ulcerative colitis. Inflamm Bowel Dis 10:215–219
Yantiss RK, Odze RD (2006) Diagnostic difficulties in inflammatory bowel disease pathology. Histopathology 48:116–132
Theodossi A, Spiegelhalter DJ, Jass J et al (1994) Observer variation and discriminatory value of biopsy features in inflammatory bowel disease. Gut 35:961–968
Cambridge G, Rampton DS, Stevens TR, McCarthy DA, Kamm M, Leaker B (1992) Anti-neutrophil antibodies in inflammatory bowel disease: prevalence and diagnostic role. Gut 33:668–674
Duerr RH, Targan SR, Landers CJ, Sutherland LR, Shanahan F (1992) Anti-neutrophil cytoplasmic antibodies in ulcerative colitis: comparison with other colitides/diarrhoeal illnesses. Gastroenterology 100:1590–1596
Peeters M, Joossens S, Vermeire S, Vliettinck R, Bossuyt X, Rutgeerts P (2001) Diagnostic value of anti-Saccharomyces cerevisiae and antineutrophil cytoplasmic autoantibodies in inflammatory bowel disease. Am J Gastroenterol 96:730–734
Vasiliauskas EA, Plevy SE, Landers CJ et al (1996) Perinuclear antineutrophil cytoplasmic antibodies in patients with Crohn’s disease define a clinical subgroup. Gastroenterology 110:1810–1819
Joossens S, Reinsch W, Vermeire S et al (2002) The value of serologic markers in indeterminate colitis: a prospective follow-up study. Gastroenterology 122:1242–1247
Hui T, Landers C, Vasiliauskas E et al (2005) Serologic responses in indeterminate colitis patients before ileal pouch-anal anastomosis may determine those at risk for continuous pouch inflammation. Dis Colon Rectum 48:1254–1262
Dendrinos KG, Becker JM, Stucchi AF, Saubermann LJ, Lamorte W, Farraye FA (2006) Anti-Saccharomyces cerevisiae antibodies are associated with the development of postoperative fistulas following ileal pouch anal anastomosis. J Gastointest Surg 10:1060–1064
Riegler G, Arimoli A, Esposito P, Iorio R, Carratu R (1997) Clinical evolution in an outpatient series with indeterminate colitis. Dis Colon Rectum 40:437–439
Stewénius J, Adnerhill I, Ekelund GR et al (1996) Risk of relapse in new cases of ulcerative colitis and indeterminate colitis. Dis Colon Rectum 39:1019–1025
Wells AD, McMillan I, Price AB, Ritchie JK, Nicholls RJ (1991) Natural history of indeterminate colitis. Br J Surg 78:179–181
Deutsch AA, McLeod RS, Cullen J, Cohen Z (1991) Results of pelvic pouch procedure in patients with Crohn’s disease. Dis Colon Rectum 34:475–477
Sagar PM, Dozois RR, Wolff BG (1996) Long term results of ileal pouch anal anastomosis in patients with Crohn’s disease. Dis Colon Rectum 39:893–898
Grobler SP, Hosie KB, Affie E, Thompson H, Keighley MR (1993) Outcome of restorative proctocolectomy when the diagnosis is suggestive of Crohn’s disease. Gut 34:1384–1388
Atkinson KG, Owen DA, Wankling G (1994) Restorative proctocolectomy and indeterminate colitis. Am J Surg 167:516–518
Bodzin JH, Klein SN, Priest SG (1995) Ileoproctostomy is preferred over ileoanal pull through in patients with indeterminate colitis. Am Surg. 61:590–593
Dayton MT, Larsen KR, Christiansen DD (2002) Similar functional results and complications after ileal pouch anal anastomosis in patients with indeterminate vs. ulcerative colitis. Arch Surg 137:690–695
Pezim ME, Pemberton JH, Beart RW Jr et al (1989) Outcome of ‘indeterminate’ colitis following ileal pouch anal anastomosis. Dis Colon Rectum 32:653–658
Pishori T, Dinnewitzer A, Zmora O et al (2004) Outcome of patients with indeterminate colitis undergoing a double stapled ileal pouch-anal anastomosis. Dis Colon Rectum 47:717–721
Gramlich T, Delaney CP, Lynch AC, Remzi FH, Fazio VW (2003) Pathological subgroups may predict complications but not late failure after ileal pouch-anal anastomosis for indeterminate colitis. Colorectal Dis 5:315–319
Tekkis PP, Heriot AG, Smith O, Smith JJ, Windsor ACJ, Nicholls RJ (2005) Long-term outcomes of restorative proctocolectomy for Crohn’s disease and indeterminate colitis. Colorectal Dis 7:218–223
Ansari A, Abdulla J, Zayyani N, Brahmi U, Taha S, Satir A (2006) A comparison of RANTES expression in Crohn’s disease and ulcerative colitis; an aid in the differential diagnosis. J Clin Pathol 59:1066–1072
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Mitchell, P.J., Rabau, M.Y. & Haboubi, N.Y. Indeterminate colitis. Tech Coloproctol 11, 91–96 (2007). https://doi.org/10.1007/s10151-007-0337-y
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DOI: https://doi.org/10.1007/s10151-007-0337-y