Inflammatory bowel disease
Indeterminate colitis

Topic Completed: 1 May 2013

Minor changes: 1 March 2021

Copyright: 2003-2021,, Inc.

PubMed Search: indeterminate colitis

Hanni Gulwani, M.B.B.S.
Page views in 2020: 2,301
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Cite this page: Gulwani H. Indeterminate colitis. website. Accessed March 4th, 2021.
Definition / general
  • Diagnosis when cannot distinguish between Crohn disease and ulcerative colitis (J Clin Pathol 1978;31:567)
  • Not a specific disease entity as it has no diagnostic criteria
  • MicroRNA expression patterns of indeterminate colitis provide molecular evidence indicating that most cases are probably ulcerative colitis, similar to the data from long-term clinical follow-up studies
  • 5 - 15% of cases of inflammatory bowel disease; up to 30% of pediatric cases (Inflamm Bowel Dis 2006;12:258)
  • Originally related to fulminant colitis requiring emergent colectomy, in which classic features of ulcerative colitis or Crohn disease were obscured by severe ulceration with early superficial fissuring, transmural lymphoid aggregates and relative rectal sparing
  • Currently often used when definitive diagnosis cannot be made at colonoscopy, biopsy or colectomy (J Clin Pathol 2004;57:1233)
  • Most patients evolve to a definite diagnosis at follow up
  • Pouch complication (43%) and removal (10%) rates are less than Crohn disease, more than ulcerative colitis (Dis Colon Rectum 2005;48:1542)
  • Pediatric cases rapidly progress to pancolitis
  • Associated carcinomas resemble those with Crohn and ulcerative colitis (Inflamm Bowel Dis 2009;15:1076)
Gross images

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Relative distal sparing

Longitudinal ulcers

Microscopic (histologic) images

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Associated with fulminant disease:

Architectural changes

Deep ulcers

Undermining ulcers

Aphthoid-like ulcers

Crypt associated granulomas

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