Marcello P W, Schoetz D J, Roberts P L, Murray J J, Coller J A, Rusin L C, Veidenheimer M C
Department of Colon and Rectal Surgery, Labey Hitchcock Medical Center, Burlington, Massachusetts 01805, USA.
Dis Colon Rectum. 1997 Mar;40(3):263-9. doi: 10.1007/BF02050413.
Inadequate initial differentiation between ulcerative colitis and Crohn's disease may lead to a diagnosis of indeterminate colitis. Construction of an ileoanal pouch in these patients may result in significant morbidity and pouch failure when the ultimate diagnosis is Crohn's disease.
We prospectively studied 543 patients with idiopathic inflammatory bowel disease to determine whether a patient's pathologic diagnosis changed with time and how it affected outcome.
Preoperative diagnosis was ulcerative colitis in 499 patients, indeterminate colitis in 42 patients, and Crohn's disease in 2 patients. Prior colectomy was performed in 58 percent of patients with ulcerative colitis and in all patients with indeterminate colitis and Crohn's disease. Postoperatively, the diagnosis changed in 20 patients with ulcerative colitis (13 to indeterminate colitis, 7 to Crohn's disease). Another two patients with indeterminate colitis showed evidence of Crohn's disease in the resected rectal specimen. As patients were followed up, an additional 13 patients were found to have Crohn's disease (5 indeterminate colitis, 8 ulcerative colitis). With the current diagnosis, perineal complications and pouch failure occurred, respectively, in 23 and in 2 percent of patients with ulcerative colitis, in 44 and in 12 percent of patients with indeterminate colitis, and in 63 and in 37 percent of patients with Crohn's disease. Pathologic diagnosis was altered in 35 patients (6 percent) overall, with a 12-fold increase in the diagnosis of Crohn's disease. Only 3 percent of patients with ulcerative colitis compared with 13 percent of patients with indeterminate colitis had a change in diagnosis to Crohn's disease (P = 0.006; Fisher's exact test).
Pouch-related complications, eventual pouch failure, and discovery of underlying Crohn's disease occurred in a significant number of patients with a diagnosis of indeterminate colitis. Until more accurate diagnostic differentiation is available, caution is advised in recommending the ileoanal pouch procedure to patients with indeterminate colitis.
溃疡性结肠炎和克罗恩病在初始阶段鉴别不清可能会导致诊断为不确定性结肠炎。当最终诊断为克罗恩病时，对这些患者进行回肠肛管袋手术可能会导致严重的发病率和袋功能衰竭。
我们对543例特发性炎症性肠病患者进行了前瞻性研究，以确定患者的病理诊断是否随时间变化以及这如何影响预后。
术前诊断为溃疡性结肠炎的患者有499例，不确定性结肠炎的患者有42例，克罗恩病的患者有2例。58%的溃疡性结肠炎患者以及所有不确定性结肠炎和克罗恩病患者此前接受过结肠切除术。术后，20例溃疡性结肠炎患者的诊断发生了改变（13例变为不确定性结肠炎，7例变为克罗恩病）。另外2例不确定性结肠炎患者在切除的直肠标本中显示有克罗恩病的证据。随着对患者的随访，又有13例患者被发现患有克罗恩病（5例原为不确定性结肠炎，8例原为溃疡性结肠炎）。根据目前的诊断，溃疡性结肠炎患者的会阴并发症和袋功能衰竭发生率分别为23%和2%，不确定性结肠炎患者分别为44%和12%，克罗恩病患者分别为63%和37%。总体而言，35例患者（6%）的病理诊断发生了改变，克罗恩病的诊断增加了12倍。与13%的不确定性结肠炎患者相比，只有3%的溃疡性结肠炎患者诊断变为克罗恩病（P = 0.006；Fisher精确检验）。
大量诊断为不确定性结肠炎的患者出现了与袋相关的并发症、最终的袋功能衰竭以及潜在克罗恩病的发现。在有更准确的诊断鉴别方法之前，建议对不确定性结肠炎患者推荐回肠肛管袋手术时要谨慎。
