Utility of New Criteria for Crohn's Disease Keiji Matsuda 1 , Hidenobu Watanabe 1 , Yoichi Ajioka 1 , Masataka Sasaki 1 , Hidetoshi Saito 1 1The First Department of Pathology, Niigata University School of Medicine Keyword: Crohn病 , 新しい診断基準 , 縦走潰瘍 , 敷石像・炎症性ポリープ , 非乾酪性類上皮肉芽腫 pp.523-537
Published Date 1996/3/25
DOI https://doi.org/10.11477/mf.1403104115
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 New criteria for Crohn's disease (CD) were applied to various inflammatory bowel diseases (IBD, to determine whether they are completely valid or not. The subjects were all surgically resected cases and consisted of 81 cases of CD,36 cases of obstructive colitis (OC),21 cases of ischemic colitis,4 cases of ischemic enteritis,6 cases of ulcerative colitis (UC),2 cases of Yersinial ileitis,2 cases of tuberculosis,2 cases of intestinal Behcet's disease and 4 cases of cancer with inflammatory polyposis. All of them had more than one longitudinal ulcer, or cobblestone appearance (+inflammatory polyposis).

 Longitudinal ulcer was observed in obstructive colitis, ischemic colitis, and Behçet's disease as well as in CD. Longitudinal ulcer of the small intestine was located along the mesentery in CD, but along the antimesenteric side in ischemic enteritis and Behçet's disease. Longitudinal ulcer of the colon developed over the colonic tenias in colonic inflammatory diseases. However, CD differed from ischemic colitis in mucosal color (yellow-white vs red) and inflammatory polyps (present vs absent), and from UC in mucosal color (yellow-white vs red) and mucosal texture (smooth vs rough). Cobblestone appearance was observed in CD, Yersinial ileitis, ischemic colitis, obstructive colitis and tuberculous ileitis. The former two were mainly composed of edema, dilatation of lymphatic channel and aggregates of lymphoid cells and showed a strongly yellow-white color, but ischemic colitis and obstructive colitis showed a strongly red color due to congestion and hemorrhage, and also yellow-white color due to edema. In Yersinial ileitis erosion and shallow ulcers occurred in lymph follicles or Peyer's patches but didn't arrange themselrees in a longitudinal line, inflammation was severe in the subserosal layer or fat tissue and neutrophilic infiltration and apoptosis was observed in some granulomas. These findings were useful markers to differentiate Yersinial ileitis from CD. Tuberculous ileitis showed red cobblestone appearance and was accompanied by caseating granulomas. In cases of colonic cancer with inflammatory polyposis and granulomas, edema was not observed outside the polyposis area and longitudinal ulcer was never observed.

 It is suggested that the new criteria for CD are useful for diagnosis of Crohn's disease, but how to differentiate CD from other inflammatory bowel disease showed be described in more detail.

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