Goldstein and Dulai developed a histologic grading scheme for evaluating backwash ileitis (BWI)in a patient with ulcerative colitis (UC). The authors are from William Beaumont Hospital in Royal Oak, Michigan.
A normal biopsy (no BWI) shows uniform villi with discernible lymphoid aggregates that may overlap.
|
Histologic Change |
Minimally Active |
Mildly Active |
|
villi |
normal |
mild blunting and widening |
|
active inflammation |
scattered neutrophils in the tips of occasional villi |
in villi and lamina propria |
|
lymphoplasmacytic inflammation |
variable increase |
present in lamina propria between lymphoid follicles |
|
extent of inflammation from IC mucosal junction |
immediately adjacent |
up to 0.5 cm |
|
crypt abscesses |
none |
none to few |
|
ulceration |
none |
none |
|
inflammatory pseudomembrane |
none |
none |
|
Histologic Change |
Moderately Active |
Markedly Active |
|
villi |
moderate to marked blunting |
marked and extensive blunting |
|
active inflammation |
abundant with edema and congestion |
severe |
|
lymphoplasmacytic inflammation |
in lamina propria and submucosa |
marked |
|
extent of inflammation from IC mucosal junction |
0.5 to 1.2 cm with zonation |
several centimeters with zonation |
|
crypt abscesses |
present, more distally |
numerous, more distally |
|
ulceration |
intact or focal erosions that may rarely penetrate the muscularis mucosae |
present, may be extensive |
|
inflammatory pseudomembrane |
none |
present |
where:
• Zonation indicates that changes are milder more proximally and more intense the closer the biopsies are taken towards the ileocecal valve.
Specialty: Gastroenterology
ICD-10: ,
