The clinical significance of focal active colitis and inflammatory bowel disease

Abstract

Abstract Purpose Focal active colitis (FAC) is a non-specific histological diagnosis of uncertain clinical significance. There is potentially a causal relationship between FAC and inflammatory bowel disease (IBD) in children, but this has not been adequately explored in adults. We sought to evaluate whether FAC is a reliable predictor of developing IBD in adults. Methods 43 patients with FAC were retrospectively identified between October 2014 and May 2019 and reviewed using the electronic pathology database at our institution. Patients with known chronic colitis were excluded. Patients were followed up for a mean period of 36 months +/- 16. Clinical data and final diagnoses were recorded, and categorical analysis performed with Fisher’s exact χ2. Results 43 patients (11 male: 32 female, mean age 53 years +/- 18) were included. 14 (33%) with FAC were subsequently diagnosed with infective colitis, 5 (12%) with IBD, of which 4 (80%) were diagnosed with ulcerative colitis and 1 (20%) was diagnosed with undetermined IBD. Of 34 patients (79%) with neither raised faecal calprotectin (FC) levels nor suspicious endoscopic findings, 1 (3%) patient subsequently developed IBD. This was statistically significant by Fisher’s exact (p = 0.0046), and the phi coefficient of 0.53 demonstrated that patients with neither raised FC levels nor suspicious endoscopic findings were statistically unlikely to develop IBD. Conclusion Our results suggest that having normal FC levels and endoscopic findings reduces the risk of future development of IBD in adults. Furthermore, a raised FC level and endoscopic features suggestive of IBD with histological FAC may predict progression to IBD.