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A Journal on Internal Medicine
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Impact Factor 1,6
Panminerva Medica 2002 September;44(3):233-6
The uncertain primary diagnosis of inflammatory bowel diseases
Miniello S., Testini M., Piccinni G., Urgesi G., Lissidini G., Tomasicchio N., Centonze A., Bonomo G. M.
Department of Application in Surgery of Innovative Technologies, Section of General and Vascular Surgery and Clinical Oncology, University of Bari, Bari, Italy
Background. The purpose of this study is to re-evaluate our series of patients affected by a colonic non-neoplastic disease, in order to measure the percentage in whom we were unable to make a correct diagnosis after the first clinical and histological approach and to single-out the reasons for our inability to reach the correct diagnosis.
Methods. During the period 1985-1999 we observed 1228 patients affected by chronic inflammatory colonic diseases.
Results. In 859 patients (69.9%) an ulcerative colitis was diagnosed for the first time, and 248 patients (20.1%) were affected by Crohn’s colitis. One hundred and twenty-one patients (9.8%) were defined as being affected by an undetermined colitis. Forty-three patients of these had a definite diagnosis, afterwards: 27 patients were affected by ulcerative colitis and 16 by Crohn’s colitis. Differential diagnosis between inflammatory large bowel diseases (ILBD) and other forms of colitis was set out as follows: 62 cases out of 1228 were consequent on a bacterial infection or parasitosis; in 28 patients a colitis pseudomembranosus was diagnosed. Eighteen cases of ischemic colitis are reported and 14 patients were affected by NSAID-related colitis. In another 6 patients we diagnosed a postradiation colitis. In 22 cases mimicking a Crohn’s colitis we ascertained 9 patients affected by intestinal lymphoma, 11 mycobacterium tuberculosis related intestinal infections and 2 cytomegalovirus related colitis.
Conclusions. Despite progress in scientific acquisitions and in diagnostic methods, correct initial diagnosis of ILBD is still difficult, even though it will be defined with time.