Predictive value of epithelial lesion heterogeneity in the etiological diagnosis of chronic inflammatory bowel disease

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Abstract Introduction Chronic inflammatory bowel diseases (IBD) are characterized by chronic, intermittent, and continuous inflammation of a part of the digestive tract, with an increased risk of dysplasia and colorectal cancer (CRC). They typically include Crohn’s disease (CD) and ulcerative colitis (UC). The diagnosis of IBD is multidisciplinary. Multiple systematic mucosal biopsies (at least two per colonic segment plus ileal sampling) are essential for establishing a diagnosis, monitoring treatment, and/or identifying complications. The analysis must account for cases of Crohn’s colitis and indeterminate colitis (IBD-U) when criteria for a classic form are not fully met. This study evaluates the predictive value of the heterogeneity of epithelial abnormalities in the etiological diagnosis of IBD. Materials and methods This is a retrospective study involving 81 cases of IBD diagnosed at the Department of Pathological Anatomy and Cytology of the Hassan II University Hospital in FES from 2021 to 2023. The diagnosis was established after histological examination. The homogeneous or heterogeneous nature of the lesions between differents biopsy sample was categorized into two groups. Correlations were made between the presence of homogeneous or heterogeneous characteristics of the lesions and the various epithelial abnormalities, as well as the clinical diagnosis of Crohn’s colitis and UC. The positive and negative predictive values were assessed. Results Our study included 81 cases of IBD. The average age of the patients was 40 years with a standard deviation of 14. All patients underwent colonic biopsy. These 81 cases were distributed as follows based on the final clinical diagnosis: 19 cases of Crohn’s colitis, 59 cases of UC, and 3 cases of indeterminate colitis on histological examination. When endoscopic and histopathological data were correlated, heterogeneous lesions were found in 44% of patients with Crohn’s colitis compared to 16% with homogeneous characteristics. In UC, homogeneous lesions were found in 84% of patients compared to 56% with heterogeneous characteristics ( P = 0.009). Conclusion Our study demonstrated that the homogeneous nature of epithelial abnormalities was more commonly observed in UC than in Crohn’s colitis. This could serve as a discriminatory histological criterion for better categorizing IBD.