Virchows Archiv

, Volume 464, Issue 5, pp 511–527 | Cite as

The histopathological approach to inflammatory bowel disease: a practice guide

  • Cord LangnerEmail author
  • Fernando Magro
  • Ann Driessen
  • Arzu Ensari
  • Gerassimos J. Mantzaris
  • Vincenzo Villanacci
  • Gabriel Becheanu
  • Paula Borralho Nunes
  • Gieri Cathomas
  • Walter Fries
  • Anne Jouret-Mourin
  • Claudia Mescoli
  • Giovanni de Petris
  • Carlos A. Rubio
  • Neil A. Shepherd
  • Michael Vieth
  • Rami Eliakim
  • Karel Geboes
Review and Perspectives


Inflammatory bowel diseases (IBDs) are lifelong disorders predominantly present in developed countries. In their pathogenesis, an interaction between genetic and environmental factors is involved. This practice guide, prepared on behalf of the European Society of Pathology and the European Crohn’s and Colitis Organisation, intends to provide a thorough basis for the histological evaluation of resection specimens and biopsy samples from patients with ulcerative colitis or Crohn’s disease. Histopathologically, these diseases are characterised by the extent and the distribution of mucosal architectural abnormality, the cellularity of the lamina propria and the cell types present, but these features frequently overlap. If a definitive diagnosis is not possible, the term indeterminate colitis is used for resection specimens and the term inflammatory bowel disease unclassified for biopsies. Activity of disease is reflected by neutrophil granulocyte infiltration and epithelial damage. The evolution of the histological features that are useful for diagnosis is time- and disease-activity dependent: early disease and long-standing disease show different microscopic aspects. Likewise, the histopathology of childhood-onset IBD is distinctly different from adult-onset IBD. In the differential diagnosis of severe colitis refractory to immunosuppressive therapy, reactivation of latent cytomegalovirus (CMV) infection should be considered and CMV should be tested for in all patients. Finally, patients with longstanding IBD have an increased risk for the development of adenocarcinoma. Dysplasia is the universally used marker of an increased cancer risk, but inter-observer agreement is poor for the categories low-grade dysplasia and indefinite for dysplasia. A diagnosis of dysplasia should not be made by a single pathologist but needs to be confirmed by a pathologist with expertise in gastrointestinal pathology.


Inflammatory bowel disease Ulcerative colitis Crohn’s disease Consensus Practice guidelines 


Conflict of interest

The authors declare no conflict of interest.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Cord Langner
    • 1
    Email author
  • Fernando Magro
    • 2
  • Ann Driessen
    • 3
  • Arzu Ensari
    • 4
  • Gerassimos J. Mantzaris
    • 5
  • Vincenzo Villanacci
    • 6
  • Gabriel Becheanu
    • 7
  • Paula Borralho Nunes
    • 8
  • Gieri Cathomas
    • 9
  • Walter Fries
    • 10
  • Anne Jouret-Mourin
    • 11
  • Claudia Mescoli
    • 12
  • Giovanni de Petris
    • 13
  • Carlos A. Rubio
    • 14
  • Neil A. Shepherd
    • 15
  • Michael Vieth
    • 16
  • Rami Eliakim
    • 17
  • Karel Geboes
    • 18
    • 19
  1. 1.Institute of PathologyMedical University of GrazGrazAustria
  2. 2.Department of GastroenterologyHospital de Sao JoaoPortoPortugal
  3. 3.Department of PathologyUniversity Hospital AntwerpEdegemBelgium
  4. 4.Department of PathologyAnkara University Medical SchoolSihhiyeTurkey
  5. 5.A’ Department of GastroenterologyEvangelismos HospitalAthensGreece
  6. 6.Institute of PathologySpedali CiviliBresciaItaly
  7. 7.Department of PathologyCarol Davila University of Medicine and PharmacyBucharestRomania
  8. 8.Instituto de Anatomia PatologicaEscola Superior de Tecnologia da Saúde de Lisboa & Faculdade de Medicina da Universidade de LisboaLisbonPortugal
  9. 9.Institute for PathologyKantonsspital BasellandLiestalSwitzerland
  10. 10.Dip di Medicina Interna e Terapia Medica U.O. Malattie di Fegato e dell’Apparato DigerenteUniversità di Messina Azienda Policlinico UniversitarioMessinaItaly
  11. 11.Department of PathologyCliniques Universitaires St Luc, UCLBrusselsBelgium
  12. 12.Department of Medicine (DIMED), Surgical Pathology and Cytopathology UnitUniversity of PaduaPaduaItaly
  13. 13.Department of Pathology and Laboratory MedicineMayo Clinic ArizonaScottsdaleUSA
  14. 14.Gastrointestinal and Liver Pathology Research LaboratoryKarolinska Institute and University HospitalStockholmSweden
  15. 15.Gloucestershire Cellular Pathology LaboratoryCheltenham General HospitalCheltenhamUK
  16. 16.Institute of PathologyKlinikum BayreuthBayreuthGermany
  17. 17.Gastroenterology and HepatologySheba Medical CenterTel HashomerIsrael
  18. 18.Department of PathologyUZ LeuvenLeuvenBelgium
  19. 19.Department of PathologyUZ GentGentBelgium

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