Résumé
Récemment un groupe de travail de la British Society of Gastroenterology (BSG) a mis au point les lignes de conduite relatives au diagnostic biopsique des maladies inflammatoires chroniques de l’intestin (MICI). Leurs lignes de conduite constituent un excellent point de départ pour la mise au point de patients suspectés de MICI, mais certains aménagements devraient permettre une meilleure standardisation de l’approche des cas de MICI. Des prélèvements adéquats en vue d’un diagnostic optimal constituent le point capital qu’il faut souligner. La distribution des modifications inflammatoires macroscopiques et microscopiques constitue une donnée importante du diagnostic différentiel entre colite ulcéreuse (CU) et maladie de Crohn (MC). La distribution segmentaire des anomalies inflammatoires doit y être jointe comme paramètre séparé de l’évaluation des données microscopiques.
Du point de vue nomenclatural, il est suggéré de faire la distinction entre colite non classifiée et colite non déterminée, et d’employer exclusivement ces termes dans le diagnostic différentiel entre CU et MC. Les termes colite fulminante, colite microscopique, colite pseudomembraneuse doivent être incorporés à la nomenclature du diagnostic histopathologique, et une définition histologique bien définie de ces termes doit être correctement appliquée.
Enfin, la conclusion du compte rendu anatomo-pathologique doit laisser une place pour une note dans laquelle l’interprétation clinique, les questions supplémentaires, les desiderata et les éléments nécessaires au diagnostic histopathologique peuvent être consignés.
Summary
Recently a working party of the British Society of Gastroenterology has developed guidelines for the biopsy diagnosis of chronic inflammatory bowel disease (IBD). The guidelines provide a useful starting point for the evaluation of patients with suspected IBD, but certain amendments could lead to a better standardized approach of an IBD patient. The importance of adequate sampling for optimal diagnosis should be emphasized more strongly. This is the case because macroscopic and microscopic distribution of the inflammatory changes are very important features to distinguish ulcerative colitis (UC) from Crohn’s disease (CD). The distribution pattern could also be included as a separate parameter in the microscopic assessment form.
As far as the nomenclature is concerned, it is suggested to make a distinction between colitis unclassified and indeterminate colitis and to use the latter term exclusively in the differential between UC and CD. The terms fulminant colitis, microscopic colitis, pseudomembranous colitis should be incorporated as histopathological diagnostic terms and a well circumscribed histological definition of these terms should be applied.
Finally, the conclusion of the pathology report should save some lines for a note, in which clinical interpretation, additional questions, desiderata and so forth concerning the histopathological diagnosis can be stated.
This is a preview of subscription content, log in via an institution to check access.
Références
JENKINS D., BALSITIS M., GALLIVAN S.et al. — Guide-lines for the biopsy diagnosis of chronic idiopathic inflammatory bowel disease.The British Society of Gastroenterology Initiative, 1995, submitted.
RIDDELL R.H. — Algorithms for the histological diagnosis of IBD: fact, hope and fantasy. In: Tytgat G.N.J., Bartelsman J.F.W.M. and Deventer S.J.H. van, editors.Inflammatory Bowel Disease, Falk Symposium 85. Dordrecht, The Netherlands: Kluwer Academic Publishers, 1995, p. 122–132.
GEBOES K., ECTORS N., D’HAENS G. and RUTGEERTS P. — The value of ileal biopsies in the diagnosis of IBD. In: Tytgat G.N.J., Bartelsman J.F.W.M. and Deventer S.J.H. van, editors.Inflammatory Bowel Disease, Falk Symposium 85. Dordrecht, The Netherlands: Kluwer Academic Publishers, 1995, p. 115–121.
THEODOSSI A., SPIEGELHALTER D.J., JASS J.et al — Observer variation and discriminatory value of biopsy features in inflammatory bowel disease.Gut, 1995,35, 961–968.
YARDLEY J.H. and DONOWITZ M. — Colorectal biopsy in inflammatory bowel disease. In: Yardley J.H., Morson B.C. and Abell M.R., editors.The Gastrointestinal Tract, International Academy of Pathology Monograph No. 18. Baltimore, USA: Williams & Wilkins, 1977, p. 50–94.
HAMILTON S.R. — Diagnosis and comparison of ulcerative colitis and Crohn’s disease involving the colon. In: Norris H.T., editor.Pathology of the colon, small intestine and anus. London, UK: Churchill Livingstone, 1991, p. 1–22.
OFFERHAUS G.J.A., DRILLENBURG P., KATE F.J.W. TEN, DULLEMEN H.M. VAN and TYTGAT G.N.J. — What is indeterminate colitis? Or what to call it if you don’t know what it is. In: Tytgat G.N.J., Bartelsman J.F.W.M. and Deventer S.J.H. van, editors.Inflammatory Bowel Disease, Falk Symposium 85. Dordrecht, The Netherlands: Kluwer Academic Publishers, 1995, p. 145–149.
PRICE A.B. — Overlap in the spectrum of non-specific inflammatory bowel disease — «colitis indeterminate».J Clin Pathol, 1978,31, 567–577.
LEVISON D.A., LAZENBY A.J. and YARDLEY J.H. — Microscopic colitis cases revisited.Gastroenterol, 1993,105, 1594–1596.
BOGOMOLETZ W.V. and FLEJOU J.-F. — Microscopic colitis: A «Transatlantic» Unifying Concept.Gastroenterol, 1994,107, 1727.
BOYCE T.G., SWERDLOW D.L. and FRIFFIN P.M. —Escherichia coli 0157: H7 and the haemolytic-uraemic syndrome.New Engl J Med, 1995,333, 364–368.
Author information
Authors and Affiliations
About this article
Cite this article
Offerhaus, G.J.A. Compte rendu de biopsie colorectale dans les maladies inflammatoires chroniques de l’intestin (MICI) — étape ultérieure d’une unification européenne. Acta Endosc 26, 97–106 (1996). https://doi.org/10.1007/BF02965794
Issue Date:
DOI: https://doi.org/10.1007/BF02965794
Mots-clés
- biopsies colorectales
- colite ulcéreuse
- compte rendu histopathologique
- maladie inflammatoire chronique de l’intestin
- maladie de Crohn