IBD - Aetiology and Pathology

Bryan Warren, Oxford

Powerpoint File

The pathology of chronic inflammatory bowel disease used to be quite straight forward. With modern treatments the differential diagnosis between ulcerative colitis and Crohn’s colitis has become really quite difficult in some cases. The cause of inflammatory bowel disease remains unknown; there are now more genetic clues to the genetic pre-disposition in that genes have been identified particularly in Crohn’s disease but there is still and unknown environmental factor playing a large part. The distribution of the disease pathologically has been used to suggest causes, such as the granulomatous vasculitis, which is described by Lundquist et al and popularised by the Royal Free Team a few years ago. More recently attempts to link Crohn’s disease to MMR vaccination have involved pathological techniquest although these have not been substantiated else where.

This talk will provide a review of the important pathological difference between Crohn’s disease and ulcerative colitis and indicate how some of these features have been attempted to be related to aetiology in the past. The talk will also indicate some of the difficulties in modern IBD practice in selecting patients who have a reliable diagnosis of ulcerative colitis as being suitable for pouch surgery.