Concept «grade-stage» in morphological diagnostics of chronic colitis in inflammatory bowel disease

Abstract

Purpose: to propose a new approach in the morphological diagnosis of colitis using the categories grade and stage to clarify and decipher the diagnosis of chronic colitis and improve the quality of biopsy diagnostics.Materials and methods. The study included 100 cases of inflammatory bowel disease (IBD) diagnosed between 2017 and 2021 (70 cases of ulcerative colitis and 30 cases of Crohn's disease). The age of the patients ranged from 19 to 53 years. In all cases, the diagnosis was established on the basis of a complex of clinical, laboratory and instrumental diagnostic methods. Multiple biopsies were obtained in all patients during colonoscopy. The processing of the biopsy material was carried out according to the generally accepted method. To evaluate plasma cells, an IHC study with antibodies to CD138 (syndecan-1) (Dako RTU) was additionally performed.Results. In the course of the study, a gradation of morphological criteria was carried out, which are decisive in the diagnosis of chronic colitis in patients with IBD. The concept of chronic colitis as a process characterized by the grade of severity and stage of chronic inflammation has been revised and re-formulated. Criteria of structural disorders (stage of colitis from 0 to 3) and criteria of severity of chronic inflammatory infiltrate (grade of colitis from 0 to 3) were identified and graded. Additionally, an attempt was made to objectify the selected criteria using an IHC study using antibodies to CD138 plasma cells (syndecan-1). Based on the material of colonobiopsies, the proposed degree-stage approach was tested in the group of colitis in patients with IBD, which showed the possibility of its practical application.Conclusion. The proposed concept will be able to improve the quality of biopsy diagnostics and avoid unjustified use of the term "chronic colitis" without further elaboration and, accordingly, its frequent unjustified use existing at the moment.