Differentiating between infections and inflammatory bowel disease
I like to use this slide whenever I lecture on the usefulness of mucosal biopsy in differentiating between infections and inflammatory bowel disease. The most important histological characteristic is that, with infectious colitis, the mucosal architecture remains normal most of the time, as shown on the left-hand panel with the nice normal parallel crypts.
Contrast this with the case of ulcerative colitis on the right, where there is marked distortion of architecture with branched glands.
The other characteristic seen in this biopsy is much more profound lamina propria inflammation with ulcerative colitis, with an increase in round cells, i.e. lymphocytes and plasma cells. Polyps are increased in infection and IBD.
Other early histological findings that suggest inflammatory bowel disease are basilar lymphoid aggregates and basal plasmacytosis.
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