The aim of this study is to describe the morphologic profile of the biopsy and resection specimen that were diagnosed with Crohn's disease and ulcerative colitis in the University of the East Ramon Magsaysay Memorial Medical Center (UERMMMC) from 2008-2016.Features that classify the specimen as Inflammatory Bowel Disease -Indeterminate Type are also presented.Considerations for the definitive IBD classification after an initial indeterminate diagnosis by morphology are also briefly discussed.Biopsy and resection specimen that were diagnosed with Crohn's disease, cannot exclude TB Colitis, are also presented; and the subsequent steps for a definitive classification are also discussed.All the patients included underwent an endoscopic biopsy, and are categorized by histopathologic diagnoses, age, sex, and GIT segment involved in the endoscopic procedure.Patients that underwent subsequent resection due to the disease condition are also identified.Comparison of the histologic findings observed in the patients, with the microscopic basis for the diagnosis recommended by the European consensus on the histopathology of inflammatory bowel disease (2013), and with the histologic features described by Patil et al., (2015) for the inflammatory disorders of the large intestine, is done.The histologic features described by Lamps (2015) for the gastrointestinal TB is used in the evaluation of the findings in the patients diagnosed with Crohn's disease, cannot exclude TB Colitis.There are 5 Crohn's disease patients, accounting for 0.8% of all patients with lower GIT inflammatory conditions, and 10 ulcerative colitis patients, accounting for 1.6% of all patients with lower GIT inflammatory conditions.Seven patients, which comprise 1.1% of all patients with lower GIT inflammatory conditions, have the diagnosis of indeterminate colitis.The histologic features of 6 out of 7 patients that had the initial diagnosis of indeterminate colitis presented with morphologic features that favored an ulcerative colitis, but with Crohn's disease features.In comparison, one patient who had an initial diagnosis of indeterminate colitis presented with morphologic features that favored Crohn's disease but with ulcerative colitis features.In these patients, correlation with chronology of symptoms and associated ancillary procedures that can classify the patients as CD or UC are recommended to the gastroenterologist attending such patients so that a more definitive classification can be done.Four patients, accounting for 0.6% of all lower GIT inflammatory conditions, were initially diagnosed as Crohn's disease, cannot exclude TB Colitis.This is in contrast with 34 patients who were diagnosed with Chronic Granulomatous Inflammation, Tuberculosis which accounted for 5.7% of all patients that were diagnosed with inflammatory conditions of the lower GIT.The remaining 536 patients were composed of acute self-limited/ infectious colitis, ischemic colitis, eosinophilic colitis, inflammatory polyp, and nonspecific inflammation.With the trend of increasing incidence of Inflammatory Bowel Disease in Asia, comparison of the more commonly seen causes of chronic inflammation of the gastrointestinal tract with a condition that appears to have a growing incidence in the region is necessary for optimal diagnostic protocol, management, and quality of care.
Abstract Background A dysregulated T-cell response is involved in the pathophysiology of inflammatory bowel diseases (IBD). T cells expressing the NKG2D activation receptor are implicated. Here, we investigated changes in intestinal T lymphocyte subsets overtime in patients treated by biotherapy for active disease. Methods In this prospective single-centre study, patients with IBD who have started a biotherapy (Infliximab, Adalimumab, Golimumab, Vedolizumab, Ustekinumab) for active disease were included. Mucosal biopsies in the inflamed segment were taken during endoscopies before treatment initiation (W0) and in the same location 14 weeks (W14) and 52 weeks (W52) after inclusion. Control biopsies were taken from 16 patients without IBD (7 ileal and 9 colonic). Immunophenotyping of isolated lymphocytes was performed by flow cytometry at each timepoint. Correlation with endoscopic response was evaluated. For Crohn’s disease (CD), the response was defined by a 50% decrease of the CDEIS score. For ulcerative colitis (UC), the response was defined by a 2 points decrease of the UCEIS Results Between February 2016 and November 2018, 85 patients were included. Forty-four were male (52%). Forty had an active CD with the most inflamed segment located for 28 in the colon and 12 in the ileum. Thirty-nine patients had active UC and 6 pouchitis. An anti-TNF was started for 51 patients (60%), Vedolizumab for 16 patients (19%) and Ustekinumab for 18 (21%). Lymphocytes phenotyping was performed at inclusion for the whole cohort, at W14 for 67 patients (79%) and at W52 for 49 patients (58%). Data concerning endoscopic response was available for all patients. At W0, IBD patients displayed higher rates of CD4 T cells and lower rates of CD8 T cells than controls (medians: 31% vs. 48% for CD4, p < 0.001 and 52% vs. 37% for CD8, p < 0.001 respectively). Endoscopic responders experienced a normalisation of these mucosal populations as compared with non-responders (W14: 58% vs. 45% for CD4, p = 0.005 and 40% vs. 28% for CD8, p = 0.03; W52 56% vs. 43% for CD4, p = 0.01 and 27 vs. 43% for CD8, p = 0.003). Results remained significant when splitting the cohort in CD and UC patients. Before treatment initiation, IBD patients displayed lower expression of NKG2D on CD8 T cells (78% vs. 94%, p < 0.001). At W52, endoscopic responders presented significantly higher expression of this marker on CD8 T cells compared with non-responders (85% vs. 68%, p < 0.001). Results remained significant in UC and CD patients. Conclusion The intestinal T cells of IBD patients with active disease present an increase of the CD4 to CD8 T-cell ratio and lower expression of NKG2D on CD8 T cells reflecting engagement of this receptor in inflammation. These T-cell parameters are normalised in endoscopic responders but not in non-responders
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