Usefulness of colonoscopy with biopsy in the evaluation of patients with chronic diarrhea

OBJECTIVE: Patients referred for chronic diarrhea frequently undergo endoscopic evaluation. There are limited data on the role for colonoscopy with biopsy and ileoscopy for patients with chronic diarrhea. METHODS: We reviewed the charts of 228 patients with chronic diarrhea evaluated by colonoscopy between November 1995 and March 1998. Chronic diarrhea was defined as loose, frequent bowel movements for a minimum of 4 wk. Patients were excluded if biopsies were not performed in normal colons, if they had undergone previous bowel surgery, a history of inflammatory bowel disease, HIV, or an inadequate colonoscopy. RESULTS: One hundred sixty-eight patients were included in the analysis, of whom 142 (85%) had ileoscopy. Colonoscopy and biopsy yielded a specific histological diagnosis in 52 (31%) patients. These included Crohn's disease (9), ulcerative colitis (7), lymphocytic colitis (10), collagenous colitis (3), ischemic colitis (3), infectious colitis (6), and miscellaneous diseases (14). Ileoscopy yielded significant findings in 3% of patients (four with Crohn's disease and one with infection). CONCLUSIONS: Colonoscopy and biopsy is useful in the investigation of patients with chronic diarrhea yielding a histological diagnosis in 31% of patients without a previous diagnosis. Ileoscopy complemented colonoscopy findings in a minority of patients with chronic diarrhea and was essential for a diagnosis in only two patients.     

Use of colonoscopy in the management of patients with Crohn's disease: Appropriateness and diagnostic yield

IntroductionColonoscopy is a necessary tool in the management of Crohn's disease, but the benefit achieved by the procedure is a matter of debate. In the present study we evaluate the clinical impact of performing colonoscopy in Crohn's disease patients.MethodsConsecutive patients with Crohn's disease undergoing colonoscopy were considered. The following issues were considered: appropriateness of indications; relevant findings able to change the management of the patients; the endoscopist's management decisions based on patient's clinical picture, i.e. increased, maintained or decreased treatment, compared with those selected after performing endoscopy.Results204 patients (116 male/88 female, mean age 41 years) were included. Colonoscopy was judged indicated in 52.9% cases, according to current guidelines. In 54% of patients, endoscopy revealed a significant lesion, and this rate was significantly lower for non-indicated procedures (25.9%, p < 0.0001). The endoscopic findings were in disagreement with symptoms in about 25% of cases, but the impact of the endoscopic findings on the endoscopist's decision was likely to be very small without any differences between appropriate and inappropriate procedures.ConclusionsEndoscopy is a potent tool in the management of Crohn's disease, if correctly used, but in the majority of cases a correct therapeutic decision may be established simply on the basis of clinical picture and non-invasive markers, whilst relevant endoscopic findings have a relatively low impact on the medical treatment.     

Skip inflammation of the appendiceal orifice: A prospective endoscopic study

Objective. The purpose of the study was to evaluate the incidence of discontinuous inflammation of the appendiceal orifice in patients undergoing colonoscopy for diagnosis or surveillance of colonic disease. Material and methods. Consecutive and unselected patients subjected to colonoscopy over a 3-year period were included in a prospective study. Biopsies were taken within 2 cm of the orifice of the appendix, from the caecum and from predefined colonic segments. Discontinuous inflammation of the appendiceal orifice was defined as an area of macroscopic inflammatory changes distinct from a normal caecum of ascending colon. The biopsies were graded histologically for the presence and severity of inflammation by a pathologist without knowledge of the endoscopic findings. Results. A total of 271 patients were included. The final diagnoses were: ulcerative colitis (UC) (83 patients), Crohn's disease (CD) (54), indeterminate colitis (12), irritable bowel syndrome (IBS) (54), microscopic colitis (15) and other disease (53). Endoscopic discontinuous inflammation of the appendiceal orifice was found in 27% (95% CI: 17–38%) of patients with UC, 24% (95% CI: 13–39%) with CD, 40% (95% CI: 12–74%) with indeterminate colitis, 8% (95% CI: 0–36%) with microscopic colitis, 10% (95% CI: 3–24%) of patients with IBS and in 9% (95% CI: 2–21%) of other diseases (p?Conclusions. Discontinuous inflammation of the appendiceal orifice is common in patients with IBD irrespective of clinical activity. However, patients with otherwise normal colon may also show congestion of this area without or with minimal microscopic inflammation.     

Leucocyte Scintigraphy to Localize Inflammatory Activity in Ulcerative Colitis and Crohn's Disease

Vilien M, Nielsen SL. Jørgensen M, Binder V, Hvid-Jacobsen K, Berild D, Kcltwck H. Leucocyte scintigraphy to localize inflammatory activity in ulcerative colitis and Crohn's disease. Scand J Gastroenterol 1992;27:582-586.

The validity of using autologous leucocytes labelled with technetium -99m hexamethyl-propyleneamine-oxine (Tc-HMPAO) for scintigraphy in inflammatory bowel disease was evaluated in 12 patients with clinically active ulcerative colitis (LJC) and 10 with Crohn's disease (CD). Colonoscopy and biopsy were used as reference. Scintigrams taken I h and 3 h after leucocyte reinjection were evaluated blindly by two independent observer groups. Full agreement was found in 11 of 12 UC patients when compared with colonoscopy but in only 3 of 10 CD patients. Segments with agreement in CD patients often showed neutrophilic granulocyte infiltration at biopsy. The judgements of clinicians and physiologists differed for only 2 of totally 70 UC segments but for 13 of 59 CD segments (kappa, 0.94 and 0.52), It is concluded that Tc-HMPAO scintigraphy might be an alternative to colonoscopy in the control of disease extent in UC. In CD patients the technique might warn about infectious complications.     

Endoscopy and Crohn's Disease: Endoscopic Approach to the Pathogenesis of Crohn's Disease

Abstract: This review describes endoscopic and histopathological findings in Crohn's disease with reference to its pathogenesis. The number of patients with Crohn's disease has markedly and rapidly increased during the last 10 years in Japan. Minute lesions such as aphthoid ulcers as an early lesion in Crohn's disease were at first discussed endoscopically and histopathologically. Recent advances concerning the mechanism of how aphthoid ulcers may occur revealed that they are induced by mucosal ischemia due to vasculitis. Longitudinal ulcers and cobblestone appearance were observed only in advanced Crohn's disease. Finally, the etiology of Crohn's disease was reviewed from the viewpoint of infectious agents and immunological abnormalities which were clarified from the study of endoscopic biopsy specimens.     

Gastral antral biopsy in the differentiation of pediatric colitides

OBJECTIVES: Differentiation of Crohn's disease (CD) from ulcerative colitis (UC) is problematic, primarily when inflammation is confined to the colon. In a historical cohort study, we evaluated the usefulness of baseline gastric antral biopsies in the differentiation of pediatric chronic colitides. METHODS: During initial investigation for suspected inflammatory bowel disease, 39 children and adolescents with colitis but normal small bowel radiography underwent pretreatment upper endoscopy concurrently with colonoscopy. Two reviewers assigned a colonoscopic diagnosis (colonic CD, UC, or indeterminate colitis) based on the macroscopic and microscopic appearances of the colonic mucosa. Antral histological findings were compared between groups using Fisher's exact test. RESULTS: Five (14%) of colonoscopic diagnoses (four indeterminate, one UC) were changed to CD by the finding of granulomatous inflammation in antral biopsies. Nonspecific antral gastritis was found in similar proportions of children and adolescents with Crohn's colitis and UC (92% vs 75%). Focal antral gastritis was more common in patients with Crohn's colitis than UC (52% vs 8%). CONCLUSIONS: Nonspecific antral gastritis is common in all forms of chronic colitis. Nevertheless, upper gastrointestinal endoscopy with biopsy is useful in the differentiation of inflammatory bowel disease confined to the colon, particularly when colonoscopic findings are indeterminate.     

Crohn's Disease: Diagnostic Procedures and Problems

Two hundred and fourteen patients with Crohn's disease (CD) were investigated by radiological methods, endoscopy, and histological examinations of multiple biopsy and surgical specimens. Radiological lesions suggestive of CD were found in all patients with small-bowel disease but in less than half of those with large-bowel CD. Endoscopic findings were conclusive in 36% of patients with small-bowel disease, in 91% of those with small- and large-bowel disease, and in 86% of those with CD of the large bowel. Histological examinations of biopsy specimens were conclusive in less than one third of the patients. Histological examination of operative specimens, however, was conclusive in 90-100% of all patients. In 43 patients initially diagnosed as having ulcerative colitis, abdominal pain was less frequent, but diarrhea and visible blood were more frequent as initial symptoms. Of these patients, 21 had combined small- and large-bowel disease at the end of the observation time. In intestinal CD, multiple biopsy specimens may disclose Crohn-specific lesions even in endoscopically normal mucosa at a distance from visible lesions.     

Is Ileoscopy With Biopsy Worthwhile in Patients Presenting With Symptoms of Inflammatory Bowel Disease?

Objective : To assess the value of adding ileoscopy with biopsy to colonoscopy, hence increasing the indications for ileoscopy in patients presenting with symptoms of inflammatory bowel disease. Methods : Two hundred fifty-seven patients with persistent diarrhea and 43 patients with sporadic colonic polyps were studied prospectively. The final diagnosis based on clinical and follow-up data, the histology of multiple ileal biopsies, and endoscopic findings were analyzed. Results : Endoscopic lesions of the terminal ileum were found in 123 of 300 patients. In the 43 patients with colonic polyps, no ileal lesions were seen. Ileal disease without colonic involvement was present in 44 of 123 patients. Microscopic lesions of the ileum were present in 125 of 300, or in 125 of 257 (49%) with symptoms of diarrhea. Two of these had a normal endoscopy. Thirteen patients had a diffuse colitis and 11 had a predominantly left-sided colitis, both originally suggestive of ulcerative colitis. Crohn's disease was diagnosed in 88 patients and infectious disease in 17. Ileal biopsies were essential for the diagnosis in 15 patients and were contributive in 53. Granulomas, solitary giant cells, pseudopyloric gland metaplasia, eosinophils, and a disturbed villous architecture were the most important lesions observed in Crohn's disease and were contributive for this diagnosis. Conclusions : Ileoscopy with biopsy is useful in carefully selected patients presenting with symptoms of inflammatory bowel disease. The main indications are diagnosis of isolated ileal disease in the presence of a normal colon and differential diagnosis in patients with pancolitis and predominantly left-sided colitis. Multiple biopsy specimens show definite pathology in almost half of the patients.     

Pediatric colonoscopy

Summary and Conclusions From 1974 to 1978, 53 colonoscopies were performed in 48 children aged from four months to 15 years using conventional fiberscopes. The majority of examinations were performed under light general anesthesia. The main indications were rectal bleeding and inflammatory bowel disease. Accuracy of barium enema in detecting polyps in this group of patients was unsatisfactory. Because of the precision of diagnosis and the possibility of simultaneous treatment of colonic polyps provided by colonoscopy, it was performed without prior radiologic examination in some children with significant rectal bleeding. In children with suspicion of nodular lymphoid hyperplasia of the colon, colonoscopy is the choice for confirmation of the diagnosis. In children with suspicion of inflammatory bowel disease a good correlation was observed between radiologic and endoscopic findings. In these cases colonoscopy should always be performed, preceded by barium enema. Colonoscopy is indicated in cases with doubtful x-rays to contribute to the diagnosis of the etiology of the inflammation and as a follow-up method of investigation in well-established cases of inflammatory bowel disease. Read at the meeting of the American Society of Colon and Rectal Surgeons, Atlanta Georgia, June 10 to 14, 1979.     

POTENTIAL OF AUTOFLUORESCENCE COLONOSCOPY FOR PATIENTS WITH ULCERATIVE COLITIS

The aim of the present paper was to determine the efficacy and potential of autofluorescence imaging (AFI) colonoscopy for patients with ulcerative colitis. Fifteen biopsy specimens were taken from endoscopic remission colonic mucosa. Eight specimens were AFI positive and seven specimens were AFI negative. While most of the histological activity findings for AFI‐positive samples were moderate active (6/8, 75.0%), most of the findings for AFI‐negative specimens were mild active (6/7, 85.7%). AFI findings for colitis‐associated cancer or dysplasia are still unclear. Further prospective studies are needed to investigate the relationship of autofluorescence findings and recurrence rate.     

Intestinal mast cell responses in idiopathic inflammatory bowel disease

Mucosal and submucosal mast cell hyperplasia is a feature of the chronic inflammatory bowel diseases—ulcerative colitis and Crohn's disease. The mast cells are often seen to be degranulated in areas of active disease, suggesting that the inflammatory mediators released from these cells contribute to the pathophysiology of these disorders. We examined the hypothesis that epithelial cell-derived proteins, intestinal epithelial cell-associated components (ECAC), interact with the mast cells of patients with chronic inflammatory bowel disease to trigger the local release of mast cell mediators. Aliquots of human intestinal mucosal mast cell suspensions obtained from surgically resected specimens of colon or small intestine (ulcerative colitis, 12; Crohn's disease, 3; histologically normal controls, 8) were incubated with 1–100 μg/ml of colon or small bowel-derived murine ECAC or control kidney protein, or 1 μg/ml goat anti-human IgE positive control for 30 min at 37°C. Supernatants were analyzed in duplicate for histamine content by fluorometric assay. The median percent total histamine released by chronic inflammatory bowel disease mast cell suspensions to colonic epithelium-derived protein (ECAC-C) was 4% histamine (range 0–20%), such that the distribution of histamine release values in inflammatory bowel disease specimens was significantly different from the distribution of values in mast cells taken from normal mucosa (median 0%,P<0.05). The median histamine release by all chronic inflammatory bowel disease specimens was also increased in response to the ECAC preparations derived from small bowel epithelium in that a third of the inflammatory bowel disease specimens showed greater than 10% histamine release to ECAC. Normal controls did not respond to either the ECAC preparations or to the kidney protein (median 0%). Our data suggest that epithelial protein-induced release of intestinal mast cell mediators may contribute to the inflammation in these chronic gastrointestinal disorders.     

Skip inflammation of the appendiceal orifice: a prospective endoscopic study

OBJECTIVE: The purpose of the study was to evaluate the incidence of discontinuous inflammation of the appendiceal orifice in patients undergoing colonoscopy for diagnosis or surveillance of colonic disease. MATERIAL AND METHODS: Consecutive and unselected patients subjected to colonoscopy over a 3-year period were included in a prospective study. Biopsies were taken within 2 cm of the orifice of the appendix, from the caecum and from predefined colonic segments. Discontinuous inflammation of the appendiceal orifice was defined as an area of macroscopic inflammatory changes distinct from a normal caecum of ascending colon. The biopsies were graded histologically for the presence and severity of inflammation by a pathologist without knowledge of the endoscopic findings. RESULTS: A total of 271 patients were included. The final diagnoses were: ulcerative colitis (UC) (83 patients), Crohn's disease (CD) (54), indeterminate colitis (12), irritable bowel syndrome (IBS) (54), microscopic colitis (15) and other disease (53). Endoscopic discontinuous inflammation of the appendiceal orifice was found in 27% (95% CI: 17-38%) of patients with UC, 24% (95% CI: 13-39%) with CD, 40% (95% CI: 12-74%) with indeterminate colitis, 8% (95% CI: 0-36%) with microscopic colitis, 10% (95% CI: 3-24%) of patients with IBS and in 9% (95% CI: 2-021%) of other diseases (p<0.05). A correlation was found for endoscopic and histological discrimination between normal and inflamed mucosa (p<0.001). However, in 24% of patients, endoscopic inflammation was without histological signs of inflammation, primarily in an otherwise normal colon. CONCLUSIONS: Discontinuous inflammation of the appendiceal orifice is common in patients with IBD irrespective of clinical activity. However, patients with otherwise normal colon may also show congestion of this area without or with minimal microscopic inflammation.     

9 Contemporary radiological examination of the lower gastrointestinal tract

The morphological spectrum of colonic disease is wide. Various treatment modalities may influence the macroscopic aspect of colonic lesions and render a pathological differential diagnosis occasionally difficult or impossible. Before starting therapy in patients suspected of having colonic disease, a physician should undertake a thorough radiological and endoscopic evaluation of the extent and severity of disease activity in the large bowel (Ruderman and Farmer, 1987).DCBE and colonoscopy are complementary imaging modalities, each test has its own intrinsic advantages and merits (Lichtenstein and Rothstein, 1991). DCBE remains the cornerstone in the detection of fistulas, strictures, perforations and estimating depth of ulcerations. Colonoscopy and biopsy remain the most sensitive imaging modalities to identify mucosal involvement (Dijkstra, 1992). The main clinically relevant discrepancies between colonoscopy and DCBE consist of inflammatory lesions without distortion of the mucosal relief and inflammation in the form of small, superficial erosions and ulcers (Dijkstra, 1992).     

Colonic biopsy practice for evaluation of diarrhea in patients with normal endoscopic findings: results from a national endoscopic database

BACKGROUND: The colonic biopsy is the only reliable method for identification of microscopic colitis in patients with chronic diarrhea and normal endoscopic findings. METHODS: The Clinical Outcomes Research Initiative national endoscopic database was analyzed to determine the rate at which colonic biopsy specimens were obtained in patients undergoing colonoscopy for the evaluation of diarrhea with no visible mucosal abnormality. RESULTS: Between January 2000 and December 2003, 5565 unique adult patients underwent colonoscopy for evaluation of diarrhea without detection of any mucosal abnormality. Colonic mucosal biopsy specimens were obtained in 4410 (79.2%) of these patients. The rates at which biopsy specimens were obtained differed among the sites where colonoscopy was performed; biopsy specimens were obtained from more patients undergoing colonoscopy in university-affiliated settings (86.8%) compared with Veterans Affairs Medical Centers (VAMC) (78.5%) or community sites (78.6%) ( p < 0.001). On multivariate analysis, biopsy specimens were more likely to be obtained in younger patients (OR 0.7: 95%CI[0.6, 0.8] for age >50 years vs. <50 years), women patients (OR 1.4: 95% CI[1.2, 1.6] in community setting; OR 4.1: 95% CI[1.6, 10.5] in VAMC setting), and patients seen in university-affiliated medical centers (university center OR 2.1: 95% CI[1.5, 3.0] vs. community setting). CONCLUSIONS: Biopsy specimens are obtained in four fifths of patients with diarrhea and normal colonoscopy findings to exclude microscopic colitis. Variation in biopsy practice exists among endoscopy site types and by gender. Clear guidelines are needed for the endoscopic approach to these patients.     

Segmental Tuberculosis of the Colon Diagnosed By Colonoscopy

Segmental tuberculosis of the colon is a rare clinical entity. In the absence of pulmonary or ileocecal involvement, colonic tuberculosis may be difficult to differentiate from neoplasm or Crohn's disease by symptomatic and radiological means. Colonoscopy and biopsy can, however, establish the diagnosis and prevent operative intervention, as indicated in the present report. A patient with a radiologically demonstrated strictured lesion of the sigmoid colon was found at colonoscopy to have several hemorrhagic transverse ulcers ranging in diameter between 1–4.5 cm. Multiple target colonoscopic biopsies, specifically from the ulcer beds, revealed necrotizing granulomas and acid-fast bacilli. Antituberculous chemotherapy produced remarkable symptomatic, radiographic and endoscopic improvements and averted exploratory laparotomy for the establishment of the diagnosis. This case report points out the importance of colonoscopic biopsy as a useful diagnostic modality in this disease.     

Acute dilatation of the colon]

Dilated colon is provoked by obstructing lesions, toxic megacolon or colonic pseudoobstruction. The obstructing lesions of the colon are colonic volvulus, inflammatory bowel disease with stenosis or colonic cancer. Toxic megacolon is more often caused by I.B.D. and rarely by infectious diseases. Etiological diagnosis is possible after clinical and radiological evaluation. Colonoscopy is always indicated, except in toxic megacolon. Balloon dilatation of strictures, palliative treatment of colonic carcinoma by Laser procedures, reduction of colonic volvulus and aspiration of colonic pseudoobstruction are the principal indications of therapeutic colonoscopy in the non surgical treatment of dilated colon.     

Role ofMycobacterium paratuberculosis in Crohn's disease

PURPOSE:Mycobacterium paratuberculosis has been proposed as a causative agent in patients with Crohn's disease. The purpose of this study was to determine whetherM. paratuberculosis was present in tissue from patients with Crohn's disease in a defined geographic area. METHODS: We prospectively evaluated, using polymerase chain reaction and culture, whetherM. paratuberculosis was present in 44 specimens (37 from intestinal mucosal biopsies and 7 from surgical resections) from patients with Crohn's disease, ulcerative colitis, or normal colonic mucosa. RESULTS: Of the 25 specimens tested from the 21 Crohn's patients, only 1 positive specimen was noted, whereas the 8 specimens from the 5 ulcerative colitis patients and the 11 specimens from the 11 control patients failed to demonstrate a positive result with polymerase chain reaction. Cultures of all specimens revealed no growth ofM. paratuberculosis. CONCLUSION:M. paratuberculosis was only rarely detected in biopsy or surgical specimens from patients with Crohn's disease. These results do not support a common causative role ofM. paratuberculosis in Crohn's disease.     

Comparison of MR Enteroclysis with Colonoscopy in Crohn's Disease-First Locust Bean Gum Study from Turkey

Background/Aim:

The aim of this study was to compare magnetic resonance enteroclysis (MRE) findings with those of colonoscopy, using locust bean gum (LBG) as an oral contrast agent in the diagnosis and follow-up of patients with Crohn''s disease.

Materials and Methods:

Nine patients with histologically proven Crohn''s disease were enrolled in this study; MRE was performed within a week of colonoscopy. All patients were examined using a 1.5 T MR Scanner after per os administration of 850 mL of a combination of LBG and mannitol. After intravenous administration of 50 mg Eritromisin and 40 mg Scopolamine, images were obtained using a T2-weighted, balanced GRE, fat-suppressed T1-weighted sequence, before and after intravenous gadolinium administration. Bowel wall thickness and enhancement of inflamatory bowel wall were measured.

Results:

The oral ingestion of LBG was well tolerated and allowed optimal small and large bowel distention in all patients. MR findings correlated with the colonoscopy results. Additional inflammatory lesions of the colon and mesenteric inflamatory changes such as lymphadenopathy, conglomerate tumor, and fistulas were demonstrated. Contrast enhancement of the affected bowel wall was markedly increased and positive correlation was obtained between bowel wall enhancement and bowel wall thickness.

Conclusion:

Gadolinium-enhanced MRE with oral locust bean gum is very efficient in the detection and follow-up of the intestinal and extraintestinal findings of Crohn''s disease.     

Prevalence, detection rate and outcome of cytomegalovirus infection in ulcerative colitis patients requiring colonic resection

OBJECTIVE: To determine the prevalence of cytomegalovirus infection in patients with steroid-refractory ulcerative colitis who required colonic resection, and to assess its possible association with the use of immunosuppressive and steroid treatment and outcome after colectomy. PATIENTS AND METHODS: The study included surgical specimens and related pre-operative endoscopic biopsy specimens of 77 consecutive ulcerative colitis patients (34 females) who underwent colectomy because of intractable steroid-refractory ulcerative colitis (55 patients), toxic megacolon (6 patients), dysplasia or cancer (7 patients) or loss of function of the colon (9 patients). Clinical features and current and past treatments were analysed. Haematoxylin and eosin and specific immunohistochemical staining for cytomegalovirus were used to detect inclusion bodies in all specimens. RESULTS: Cytomegalovirus infection was found in 15 of 55 steroid-refractory ulcerative colitis patients (27.3%) and in 2 of 22 non-refractory patients (9.1%) (p=0.123). Only six patients had positive staining for cytomegalovirus in pre-operative endoscopic biopsy specimens. Detection of cytomegalovirus inclusion in biopsy specimens was not related to the number of biopsies or to time that had elapsed since colonoscopy and index surgery. Cytomegalovirus-positive patients were more likely to be on systemic corticosteroids (p=0.03). In contrast, current use and duration of immunosuppressive treatment, number of steroid cycles since diagnosis and in the last year, as well as chronic use of steroid in the last year were not significantly related to cytomegalovirus infection. Cytomegalovirus-positive patients did not receive antiviral therapy following proctocolectomy but did not show endoscopic or histological cytomegalovirus reactivation in the ileo-anal pouch and in the remaining bowel. CONCLUSIONS: Cytomegalovirus infection is frequently found in surgical specimens of patients with steroid-refractory ulcerative colitis and is more likely in patients on corticosteroid treatment. Cytomegalovirus infection is frequently unrecognised in pre-operative biopsy specimens, thus raising concerns about the accuracy of the available diagnostic tools. Unrecognised and untreated cytomegalovirus infection does not affect the outcome of ulcerative colitis patients following proctocolectomy.     

The microscopic distribution of 99mTc-labelled phagocytes in resected bowel in patients with acute Crohn's disease: correlation with histological changes

Abdominal scintiscans performed after the injection of autologous phagocytes labelled with ^99mTc-stannous colloid particles provide an accurate assessment of the extent of disease in active inflammatory bowel disease. To study the correlation between phagocyte accumulation and histological indices of the degree of inflammation within bowel wall, the distribution of radiolabel within five freshly resected specimens of ileum and one of colon was assessed in five patients with active Crohn's disease. Each patient was injected with autologous ^99mTc-labelled phagocytes prior to surgery. Multiple tissue samples (blocks) were taken along the length of the fresh resected specimen of bowel. The radioactive count of each block was obtained and they were then studied independently by two histopathologists who graded 12 histological features according to predefined criteria. High counts correlated with ulceration and submucosal mononuclear aggregates (P < 0.05). Very low counts were obtained in mesentery and non-ulcerated bowel. This study confirms the selective accumulation of ^99mTc-labelled phagocytes within areas of ulcerated bowel in patients with active Crohn's disease.