Full Text:   <2830>

CLC number: R574

On-line Access: 2011-04-06

Received: 2010-05-10

Revision Accepted: 2010-10-18

Crosschecked: 2011-01-25

Cited: 8

Clicked: 5661

Citations:  Bibtex RefMan EndNote GB/T7714

-   Go to

Article info.
Open peer comments

Journal of Zhejiang University SCIENCE B 2011 Vol.12 No.4 P.280-286


Inflammatory bowel disease unclassified

Author(s):  Ning Zhou, Wei-xing Chen, Shao-hua Chen, Cheng-fu Xu, You-ming Li

Affiliation(s):  Department of Gastroenterology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China

Corresponding email(s):   zlym@zju.edu.cn

Key Words:  Inflammatory bowel disease unclassified, Ulcerative colitis, Crohn’, s disease, Subtype, Diagnosis

Ning Zhou, Wei-xing Chen, Shao-hua Chen, Cheng-fu Xu, You-ming Li. Inflammatory bowel disease unclassified[J]. Journal of Zhejiang University Science B, 2011, 12(4): 280-286.

@article{title="Inflammatory bowel disease unclassified",
author="Ning Zhou, Wei-xing Chen, Shao-hua Chen, Cheng-fu Xu, You-ming Li",
journal="Journal of Zhejiang University Science B",
publisher="Zhejiang University Press & Springer",

%0 Journal Article
%T Inflammatory bowel disease unclassified
%A Ning Zhou
%A Wei-xing Chen
%A Shao-hua Chen
%A Cheng-fu Xu
%A You-ming Li
%J Journal of Zhejiang University SCIENCE B
%V 12
%N 4
%P 280-286
%@ 1673-1581
%D 2011
%I Zhejiang University Press & Springer
%DOI 10.1631/jzus.B1000172

T1 - Inflammatory bowel disease unclassified
A1 - Ning Zhou
A1 - Wei-xing Chen
A1 - Shao-hua Chen
A1 - Cheng-fu Xu
A1 - You-ming Li
J0 - Journal of Zhejiang University Science B
VL - 12
IS - 4
SP - 280
EP - 286
%@ 1673-1581
Y1 - 2011
PB - Zhejiang University Press & Springer
ER -
DOI - 10.1631/jzus.B1000172

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.

Darkslateblue:Affiliate; Royal Blue:Author; Turquoise:Article


[1]Arai, R., 2010. Serologic markers: impact on early diagnosis and disease stratification in inflammatory bowel disease. Postgrad. Med., 122(4):177-185.

[2]Ashorn, S., Honkanen, T., Kolho, K.L., Ashorn, M., Välineva, T., Wei, B., Braun, J., Rantala, I., Luukkaala, T., Iltanen, S., 2009. Fecal calprotectin levels and serological responses to microbial antigens among children and adolescents with inflammatory bowel disease. Inflamm. Bowel Dis., 15(2):199-205.

[3]Bastida, G., Nos, P., Aguas, M., Beltrán, B., Iborra, M., Ortiz, V., Garrigues, V., Estevan, R., Ponce, J., 2010. The effects of thiopurine therapy on health-related quality of life in inflammatory bowel disease patients. BMC Gastroenterol., 10(1):26.

[4]Bodzin, J.H., Klein, S.N., Priest, S.G., 1995. Ileoproctostomy is preferred over ileoanal pull-through in patients with indeterminate colitis. Am. Surg., 61(7):590-593.

[5]Bordeianou, L., Kunitake, H., Shellito, P., Hodin, R., 2010. Preoperative infliximab treatment in patients with ulcerative and indeterminate colitis does not increase rate of conversion to emergent and multistep abdominal surgery. Int. J. Colorectal Dis., 25(3):401-404.

[6]Branco, B.C., Harpaz, N., Sachar, D.B., Greenstein, A.J., Tabrizian, P., Bauer, J.J., Greenstein, A.J., 2009. Colorectal carcinoma in indeterminate colitis. Inflamm. Bowel Dis., 15(7):1076-1081.

[7]Burakoff, R., 2004. Indeterminate colitis: clinical spectrum of disease. J. Clin. Gastroenterol., 38(Suppl. 1):S41-S43.

[8]Carvalho, R.S., Abadom, V., Dilworth, H.P., Thompson, R., Oliva-Hemker, M., Cuffari, C., 2006. Indeterminate colitis: a significant subgroup of pediatric IBD. Inflamm. Bowel Dis., 12(4):258-262.

[9]da Luz Moreira, A., Kiran, R.P., Lavery, I., 2010. Clinical outcomes of ileorectal anastomosis for ulcerative colitis. Br. J. Surg., 97(1):65-69.

[10]Dayton, M.T., Larsen, K.R., Christiansen, D.D., 2002. Similar functional results and complications after ileal pouch-anal anastomosis in patients with indeterminate vs. ulcerative colitis. Arch. Surg., 137(6):690-695.

[11]Dotan, I., 2010. New serologic markers for inflammatory bowel disease diagnosis. Dig. Dis., 28(3):418-423.

[12]Dubinsky, M.C., 2010. Serologic and laboratory markers in prediction of the disease course in inflammatory bowel disease. World J. Gastroenterol., 16(21):2604-2608.

[13]Gapasin, J., van Langenberg, D.R., Holtmann, G., Hetzel, D.J., Andrews, J.M., 2010. Potentially avoidable surgery in IBD: what proportion of patients come to resection without optimal preoperative therapy? A guidelines-based audit. Intern. Med. J., Epub ahead of print

[14]Geboes, K., de Hertogh, G., 2003. Indeterminate colitis. Inflamm. Bowel Dis., 9(5):324-331.

[15]Geboes, K., Colombel, J.F., Greenstein, A., Jewell, D.P., Sandborn, W.J., Vatn, M.H., Warren, B., Riddell, R.H., 2008. Indeterminate colitis: a review of the concept—what’s in a name? Inflamm. Bowel Dis., 14(6):850-857.

[16]Gornet, J.M., Couve, S., Hassani, Z., Delchier, J.C., Marteau, P., Cosnes, J., Bouhnik, Y., Dupas, J.L., Modigliani, R., Taillard, F., et al., 2003. Infliximab for refractory ulcerative colitis or indeterminate colitis: an open-label multicentre study. Aliment. Pharmacol. Ther., 18(2):175-181.

[17]Gramlich, T., Delaney, C.P., Lynch, A.C., Remzi, F.H., Fazio, V.W., 2003. Pathological subgroups may predict complications but not late failure after ileal pouch-anal anastomosis for indeterminate colitis. Colorectal. Dis., 5(4):315-319.

[18]Guindi, M., Riddell, R.H., 2004. Indeterminate colitis. J. Clin. Pathol., 57(12):1233-1244.

[19]Hanai, H., 2008. Leucocytapheresis for inflammatory bowel disease in the era of biologic therapy. Eur. J. Gastroenterol. Hepatol., 20(7):596-600.

[20]Joossens, S., Reinisch, W., Vermiere, S., Sendid, B., Poulain, D., Peeters, M., Geboes, K., Bossuyt, X., Vandewalle, P., Oberhuber, G., et al., 2002. The value of ASCA and ANCA in IC: a prospective follow up study. Gastroenterology, 122(5):1242-1247.

[21]Leighton, J.A., Legnani, P., Seidman, E.G., 2007. Role of capsule endoscopy in inflammatory bowel disease: where we are and where we are going. Inflamm. Bowel Dis., 13(3):331-337.

[22]Lindberg, A., Eberhardson, M., Karlsson, M., Karlén, P., 2010. Long-term follow-up with granulocyte and monocyte apheresis re-treatment in patients with chronically active inflammatory bowel disease. BMC Gastroenterol., 10(1):73.

[23]Marcello, P.W., Schoetz, D.J.Jr., Roberts, P.L., Murray, J.J., Coller, J.A., Rusin, L.C., Veidenheimer, M.C., 1997. Evolutionary changes in the pathologic diagnosis after the ileoanal pouch procedure. Dis. Colon Rectum, 40(3):263-269.

[24]Martland, G.T., Shepherd, N.A., 2007. Indeterminate colitis: definition, diagnosis, implications and a plea for nosological sanity. Histopathology, 50(1):83-96.

[25]Meucci, G., Bortoli, A., Riccioli, F.A., Girelli, C.M., Radaelli, F., Rivolta, R., Tatarella, M., 1999. Frequency and clinical evolution of indeterminate colitis: a retrospective multi-centre study in northern Italy. GSMII (Gruppo di Studio per le Malattie Infiammatorie Intestinali). Eur. J. Gastroenterol. Hepatol., 11(8):909-913.

[26]Moscandrew, M.E., Loftus, E.V.Jr., 2009. Diagnostic advances in inflammatory bowel disease (imaging and laboratory). Curr. Gastroenterol. Rep., 11(6):488-495.

[27]Murrell, Z.A., Melmed, G.Y., Ippoliti, A., Vasiliauskas, E.A., Dubinsky, M., Targan, S.R., Fleshner, P.R., 2009. 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, 52(5):872-878.

[28]Ngo, B., Farrell, C.P., Barr, M., Wolov, K., Bailey, R., Mullin, J.M., Thornton, J.J., 2010. Tumor necrosis factor blockade for treatment of inflammatory bowel disease: efficacy and safety. Curr. Mol. Pharmacol., 3(3):145-152.

[29]Notteghem, B., Salomez, J.L., Gower-Rousseau, C., Marti, R., Lemahieu, M., Nuttens, M.C., Dupas, J.L., Colombel, J.F., Cortot, A., 1993. What is the prognosis in unclassified colitis? Results of a cohort study of 104 patients in the Northern-Pas-de-Calais region. Gastroenterol. Clin. Biol., 17(11):811-815.

[30]Pearce, C.B., Lawrance, I.C., 2007. Careful patient selection may improve response rates to infliximab in inflammatory bowel disease. J. Gastroenterol. Hepatol., 22(10):1671-1677.

[31]Pezim, M.E., Pemberton, J.H., Beart, R.W.Jr., Wolff, B.G., Dozois, R.R., Nivatvongs, S., Devine, R., Ilstrup, D.M., 1989. Outcome of “indeterminant” colitis following ileal pouch-anal anastomosis. Dis. Colon Rectum, 32(8):653-658.

[32]Romano, C., Famiani, A., Gallizzi, R., Comito, D., Ferrau′, V., Rossi, P., 2008. Indeterminate colitis: a distinctive clinical pattern of inflammatory bowel disease in children. Pediatrics, 122(6):e1278-e1281.

[33]Satsangi, J., Silverberg, M.S., Vermeire, S., Colombel, J.F., 2006. The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. Gut, 55(6):749-753.

[34]Stange, E.F., Travis, S.P., Vermeire, S., Beglinger, C., Kupcinkas, L., Geboes, K., Barakauskiene, A., Villanacci, V., von Herbay, A., Warren, B.F., et al., 2006. European evidence based consensus on the diagnosis and management of Crohn’s disease: definitions and diagnosis. Gut, 55(Suppl. 1):i1-i15.

[35]Suzuki, H., Fukuda, Y., Koizuka, H., Tomita, T., Hori, K., Suzuki, M., O′Morain, C., 2008. Dietary antigens in Crohn’s disease: antibodies to porcine pancreatic amylase. Am. J. Gastroenterol., 103(3):656-664.

[36]Talbot, I.C., 2005. Indeterminate colitis: a pathologist’s view. Dig. Liver Dis., 37(9):713-715.

[37]Tan, T., Lawrance, I.C., 2009. Use of mycophenolate mofetil in inflammatory bowel disease. World J. Gastroenterol., 15(13):1594-1599.

[38]Tekkis, P.P., Heriot, A.G., Smith, O., Smith, J.J., Windsor, A.C., Nicholls, R.J., 2005. Long-term outcomes of restorative proctocolectomy for Crohn’s disease and indeterminate colitis. Colorectal Dis., 7(3):218-223.

[39]Thia, K.T., Li, M., Ling, K.L., Kong, S.C., Ooi, C.J., 2011. Azathioprine is effective in corticosteroid-dependent Asian inflammatory bowel disease patients. Inflamm. Bowel Dis., 17(3):809-815.

[40]Vandewalle-El Khoury, P., Colombel, J.F., Joossens, S., Standaert-Vitse, A., Collot, M., Halfvarson, J., Ayadi, A., Landers, C.J., Vermeire, S., Rutgeerts, P., et al., 2008. Detection of antisynthetic mannoside antibodies (AΣMA) reveals heterogeneity in the ASCA response of Crohn’s disease patients and contributes to differential diagnosis, stratification, and prediction. Am. J. Gastroenterol., 103(4):949-957.

[41]Wells, A.D., McMillan, I., Price, A.B., Ritchie, J.K., Nicholls, R.J., 1991. Natural history of indeterminate colitis. Br. J. Surg., 78(2):179-181.

[42]Yantiss, R.K., Odze, R.D., 2006. Diagnostic difficulties in inflammatory bowel disease pathology. Histopathology, 48(2):116-132.

Open peer comments: Debate/Discuss/Question/Opinion


Please provide your name, email address and a comment

Journal of Zhejiang University-SCIENCE, 38 Zheda Road, Hangzhou 310027, China
Tel: +86-571-87952783; E-mail: cjzhang@zju.edu.cn
Copyright © 2000 - 2024 Journal of Zhejiang University-SCIENCE