Goldstein and Dulai listed histologic features that favor the diagnosis of Crohn’s Disease (CD) over backwash ileitis (BWI) in a patient with ulcerative colitis (UC). The authors are from William Beaumont Hospital in Royal Oak, Michigan.


Histologic features favoring the diagnosis of Crohn’s Disease:

(1) extensive length of ileal involvement

(2) involvement of the jejunum

(3) proximal areas of active ileitis with skip lesions of uninvolved distal ileum or cecum

(4) greater mucosal damage and inflammation in the terminal ileum than in the cecum

(5) transmural ileal inflammation with neural hyperplasia and granulomas

(6) pyloric gland metaplasia of the ileal mucosa

(7) focal ileal erosions with mild active ileitis plus mild cecal colitis

(8) edema in the lamina propria with crypt disarray in the terminal ileum with little or no inflammation in the villus tip


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