Skip to main content
SpringerLink
Log in

Indeterminate colitis

  • Review
  • Published:
Techniques in Coloproctology Aims and scope Submit manuscript

Abstract

The term indeterminate colitis has been used to describe cases of inflammatory bowel disease that cannot be classified as ulcerative colitis or Crohn’s disease. However, this term has suffered varying definitions, which in addition to numerous difficulties in diagnosing inflammatory bowel disease has led to much confusion. The term indeterminate colitis should only be used in cases where a colectomy has been performed and the overlapping features of Crohn’s disease and ulcerative colitis do not allow a definitive diagnosis. Over time the majority of patients remain with a diagnosis of indeterminate colitis, or show symptoms similar to ulcerative colitis. Ileal pouch-anal anastomosis surgery can be performed in such patients, with outcomes of pouch failure and functional outcome that are similar to those in patients with ulcerative colitis but with increased risk of postoperative pouch complications. This review addresses the definition of indeterminate colitis, its pathology, natural history, and outcomes of restorative proctocolectomy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Price AB (1978) Overlap in the spectrum of non-specific inflammatory bowel disease — ‘colitis indeterminate’ J Clin Pathol 31:567–577

    Article  CAS  PubMed  Google Scholar 

  2. Lee KS, Medline A, Shockey S (1979) Indeterminate colitis in the spectrum of inflammatory bowel disease. Arch Pathol Lab Med 103:173–176

    CAS  PubMed  Google Scholar 

  3. Farmer M, Petras RE, Hunt LE, Janosky JE, Galanduik S (2000) The importance of diagnostic accuracy in colonic inflammatory bowel disease. Am J Gastroenterol 95:3184–3188

    Article  CAS  PubMed  Google Scholar 

  4. Yu CS, Pemberton JH, Larson D (2000) Ileal pouch-anal anastomosis in patients with indeterminate colitis. Long term results. Dis Colon Rectum 43:1487–1496

    Article  CAS  PubMed  Google Scholar 

  5. Koltun WA, Schoetz DJ Jr, Roberts PL, Murray JJ, Coller JA, Veidenheimer MC (1991) Indeterminate colitis predisposes to perineal complications after ileal pouch-anal anastomosis. Dis Colon Rectum 34:857–860

    Article  CAS  PubMed  Google Scholar 

  6. Meucci G, Bortoli A, Riccioli FA et al (1999) Frequency and clinical evolution of indeterminate colitis: a retrospective multi-centre study in northern Italy. Eur J Gastroenterol Hepatol 11:909–913

    Article  CAS  PubMed  Google Scholar 

  7. Satsangi J, Silverberg MS, Vermeire S, Colombel JF (2006) The Montreal classification of inflammatory bowel disease: controversies, consensus and implications. Gut 55:749–753

    Article  CAS  PubMed  Google Scholar 

  8. Brown CJ, MacLean AR, Cohen Z, MacRae HM, O’Connor BI, McLeod RS (2005) Crohn’s disease and indeterminate colitis and the ileal pouch-anal anastomosis: outcomes and patterns of failure. Dis Colon Rectum 48:1542–1549

    Article  PubMed  Google Scholar 

  9. Marcello PW, Schoetz DJ, Roberts PL et al (1997) Evolutionary changes in the pathologic diagnosis after the ileoanal pouch procedure. Dis Colon Rectum 40:263–269

    Article  CAS  PubMed  Google Scholar 

  10. Rudolph WG, Uthoff SMS, McAuliffe TL, Goode ET, Petras RE, Galandiuk S (2002) Indeterminate colitis: the real story. Dis Colon Rectum 45:1528–1534

    Article  PubMed  Google Scholar 

  11. Delaney CP, Remzi FH, Gramlich T, Dadvand B, Fazio VW (2002) Equivalent function, quality of life and pouch survival rates after ileal pouch-anal anastomosis for indeterminate colitis and ulcerative colitis. Ann Surg 236:43–48

    Article  PubMed  Google Scholar 

  12. Swan NC, Geoghegan JG, O’Donoghue DP, Hyland JMP, Sheahan K (1998) Fulminant colitis in inflammatory bowel disease. Detailed pathologic and clinical analysis. Dis Colon Rectum 41:1511–1515

    Article  CAS  PubMed  Google Scholar 

  13. Odze RD (2003) Diagnostic problems and advances in inflammatory bowel disease. Mod Pathol 16:347–358

    Article  PubMed  Google Scholar 

  14. D’Haens G, Geboes K, Peeters M, Baert F, Ectors N, Rutgeerts P (1997) Patchy caecal inflammation associated with distal ulcerative colitis: a prospective endoscopic study. Am J Gastroenterol 92:1275–1279

    PubMed  Google Scholar 

  15. Mutinga ML, Odze RD, Wang HH, Hornick JL, Farraye FA (2004) The clinical significance of right-sided colonic inflammation in patients with left sided chronic ulcerative colitis. Inflamm Bowel Dis 10:215–219

    Article  PubMed  Google Scholar 

  16. Yantiss RK, Odze RD (2006) Diagnostic difficulties in inflammatory bowel disease pathology. Histopathology 48:116–132

    Article  CAS  PubMed  Google Scholar 

  17. Theodossi A, Spiegelhalter DJ, Jass J et al (1994) Observer variation and discriminatory value of biopsy features in inflammatory bowel disease. Gut 35:961–968

    Article  CAS  PubMed  Google Scholar 

  18. Cambridge G, Rampton DS, Stevens TR, McCarthy DA, Kamm M, Leaker B (1992) Anti-neutrophil antibodies in inflammatory bowel disease: prevalence and diagnostic role. Gut 33:668–674

    Article  CAS  PubMed  Google Scholar 

  19. Duerr RH, Targan SR, Landers CJ, Sutherland LR, Shanahan F (1992) Anti-neutrophil cytoplasmic antibodies in ulcerative colitis: comparison with other colitides/diarrhoeal illnesses. Gastroenterology 100:1590–1596

    Google Scholar 

  20. Peeters M, Joossens S, Vermeire S, Vliettinck R, Bossuyt X, Rutgeerts P (2001) Diagnostic value of anti-Saccharomyces cerevisiae and antineutrophil cytoplasmic autoantibodies in inflammatory bowel disease. Am J Gastroenterol 96:730–734

    Article  CAS  PubMed  Google Scholar 

  21. Vasiliauskas EA, Plevy SE, Landers CJ et al (1996) Perinuclear antineutrophil cytoplasmic antibodies in patients with Crohn’s disease define a clinical subgroup. Gastroenterology 110:1810–1819

    Article  CAS  PubMed  Google Scholar 

  22. Joossens S, Reinsch W, Vermeire S et al (2002) The value of serologic markers in indeterminate colitis: a prospective follow-up study. Gastroenterology 122:1242–1247

    Article  PubMed  Google Scholar 

  23. Hui T, Landers C, Vasiliauskas E et al (2005) Serologic responses in indeterminate colitis patients before ileal pouch-anal anastomosis may determine those at risk for continuous pouch inflammation. Dis Colon Rectum 48:1254–1262

    Article  PubMed  Google Scholar 

  24. Dendrinos KG, Becker JM, Stucchi AF, Saubermann LJ, Lamorte W, Farraye FA (2006) Anti-Saccharomyces cerevisiae antibodies are associated with the development of postoperative fistulas following ileal pouch anal anastomosis. J Gastointest Surg 10:1060–1064

    Article  Google Scholar 

  25. Riegler G, Arimoli A, Esposito P, Iorio R, Carratu R (1997) Clinical evolution in an outpatient series with indeterminate colitis. Dis Colon Rectum 40:437–439

    Article  CAS  PubMed  Google Scholar 

  26. Stewénius J, Adnerhill I, Ekelund GR et al (1996) Risk of relapse in new cases of ulcerative colitis and indeterminate colitis. Dis Colon Rectum 39:1019–1025

    Article  PubMed  Google Scholar 

  27. Wells AD, McMillan I, Price AB, Ritchie JK, Nicholls RJ (1991) Natural history of indeterminate colitis. Br J Surg 78:179–181

    Article  CAS  PubMed  Google Scholar 

  28. Deutsch AA, McLeod RS, Cullen J, Cohen Z (1991) Results of pelvic pouch procedure in patients with Crohn’s disease. Dis Colon Rectum 34:475–477

    Article  CAS  PubMed  Google Scholar 

  29. Sagar PM, Dozois RR, Wolff BG (1996) Long term results of ileal pouch anal anastomosis in patients with Crohn’s disease. Dis Colon Rectum 39:893–898

    Article  CAS  PubMed  Google Scholar 

  30. Grobler SP, Hosie KB, Affie E, Thompson H, Keighley MR (1993) Outcome of restorative proctocolectomy when the diagnosis is suggestive of Crohn’s disease. Gut 34:1384–1388

    Article  CAS  PubMed  Google Scholar 

  31. Atkinson KG, Owen DA, Wankling G (1994) Restorative proctocolectomy and indeterminate colitis. Am J Surg 167:516–518

    Article  CAS  PubMed  Google Scholar 

  32. Bodzin JH, Klein SN, Priest SG (1995) Ileoproctostomy is preferred over ileoanal pull through in patients with indeterminate colitis. Am Surg. 61:590–593

    CAS  PubMed  Google Scholar 

  33. Dayton MT, Larsen KR, Christiansen DD (2002) Similar functional results and complications after ileal pouch anal anastomosis in patients with indeterminate vs. ulcerative colitis. Arch Surg 137:690–695

    Article  PubMed  Google Scholar 

  34. Pezim ME, Pemberton JH, Beart RW Jr et al (1989) Outcome of ‘indeterminate’ colitis following ileal pouch anal anastomosis. Dis Colon Rectum 32:653–658

    Article  CAS  PubMed  Google Scholar 

  35. Pishori T, Dinnewitzer A, Zmora O et al (2004) Outcome of patients with indeterminate colitis undergoing a double stapled ileal pouch-anal anastomosis. Dis Colon Rectum 47:717–721

    Article  PubMed  Google Scholar 

  36. Gramlich T, Delaney CP, Lynch AC, Remzi FH, Fazio VW (2003) Pathological subgroups may predict complications but not late failure after ileal pouch-anal anastomosis for indeterminate colitis. Colorectal Dis 5:315–319

    Article  CAS  PubMed  Google Scholar 

  37. Tekkis PP, Heriot AG, Smith O, Smith JJ, Windsor ACJ, Nicholls RJ (2005) Long-term outcomes of restorative proctocolectomy for Crohn’s disease and indeterminate colitis. Colorectal Dis 7:218–223

    Article  CAS  PubMed  Google Scholar 

  38. Ansari A, Abdulla J, Zayyani N, Brahmi U, Taha S, Satir A (2006) A comparison of RANTES expression in Crohn’s disease and ulcerative colitis; an aid in the differential diagnosis. J Clin Pathol 59:1066–1072

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Royal Preston Hospital, Fulwood, Preston, Lancashire, UK

    P. J. Mitchell

  2. Coloproctology Unit Tel Aviv Sourasky Medical Center The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    M. Y. Rabau

  3. Department of Surgical Pathology, Trafford Healthcare NHS Trust, Davyhulme, Manchester, M41 5SL, UK

    N. Y. Haboubi

Authors
  1. P. J. Mitchell
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Y. Rabau
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. N. Y. Haboubi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to N. Y. Haboubi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mitchell, P.J., Rabau, M.Y. & Haboubi, N.Y. Indeterminate colitis. Tech Coloproctol 11, 91–96 (2007). https://doi.org/10.1007/s10151-007-0337-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10151-007-0337-y

Key words

Search

Navigation