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World J Gastroenterol. Jan 7, 2015; 21(1): 21-46
Published online Jan 7, 2015. doi: 10.3748/wjg.v21.i1.21
Differential diagnosis in inflammatory bowel disease colitis: State of the art and future perspectives
Gian Eugenio Tontini, Maurizio Vecchi, Luca Pastorelli, Markus F Neurath, Helmut Neumann
Gian Eugenio Tontini, Maurizio Vecchi, Luca Pastorelli, Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy
Gian Eugenio Tontini, Markus F Neurath, Helmut Neumann, Department of Medicine I, University of Erlangen-Nuremberg, 91054 Erlangen, Germany
Maurizio Vecchi, Luca Pastorelli, Department of Biomedical Sciences for Health, University of Milan, 20122 Milano, Italy
Author contributions: Tontini GE designed the study, performed the literature research, and wrote the manuscript; Vecchi M provided a critical revision of the manuscript for important intellectual content, wrote the manuscript, and supervised the study; Pastorelli L provided a critical revision of the manuscript for important intellectual content and wrote the manuscript; Neurath MF provided a critical revision of the manuscript for important intellectual content; Neumann H designed the study and provided a critical revision of the manuscript for important intellectual content.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Gian Eugenio Tontini, MD, PhD, Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, via Morandi 30, 20097 San Donato Milanese, Italy. gianeugeniotontini@libero.it
Telephone: +39-2-52774655 Fax: +39-2-52774652-55
Received: July 16, 2014
Peer-review started: July 16, 2014
First decision: August 15, 2014
Revised: October 3, 2014
Accepted: November 7, 2014
Article in press: November 11, 2014
Published online: January 7, 2015
Processing time: 231 Days and 23.4 Hours
Abstract

Distinction between Crohn’s disease of the colon-rectum and ulcerative colitis or inflammatory bowel disease (IBD) type unclassified can be of pivotal importance for a tailored clinical management, as each entity often involves specific therapeutic strategies and prognosis. Nonetheless, no gold standard is available and the uncertainty of diagnosis may frequently lead to misclassification or repeated examinations. Hence, we have performed a literature search to address the problem of differential diagnosis in IBD colitis, revised current and emerging diagnostic tools and refined disease classification strategies. Nowadays, the differential diagnosis is an untangled issue, and the proper diagnosis cannot be reached in up to 10% of patients presenting with IBD colitis. This topic is receiving emerging attention, as medical therapies, surgical approaches and leading prognostic outcomes require more and more disease-specific strategies in IBD patients. The optimization of standard diagnostic approaches based on clinical features, biomarkers, radiology, endoscopy and histopathology appears to provide only marginal benefits. Conversely, emerging diagnostic techniques in the field of gastrointestinal endoscopy, molecular pathology, genetics, epigenetics, metabolomics and proteomics have already shown promising results. Novel advanced endoscopic imaging techniques and biomarkers can shed new light for the differential diagnosis of IBD, better reflecting diverse disease behaviors based on specific pathogenic pathways.

Keywords: Crohn’s disease; Ulcerative colitis; Inflammatory bowel disease unclassified; Advanced endoscopic imaging; Biomarkers; Histopathology

Core tip: Distinction between Crohn’s disease and ulcerative colitis or inflammatory bowel disease (IBD) type unclassified can be of pivotal importance for a tailored clinical management, as each entity often involves specific therapeutic strategies and prognosis. Nonetheless, the differential diagnosis is an untangled issue, and the proper diagnosis cannot be reached in up to 10% of patients presenting with colitis. Hence, we address the problem of differential diagnosis in IBD colitis, thereby revising current and emerging diagnostic tools to refine disease classification.