title: The uncertain primary diagnosis of inflammatory bowel diseases.
abstract: 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.
authors.affiliation: Department of Application in Surgery of Innovative, Technologies, Section of General and Vascular Surgery and Clinical Oncology, University of Bari, Bari, Italy. mario.testini@tin.it
authors.forename: S
authors.initials: S
authors.lastname: Miniello
authors.forename: M
authors.initials: M
authors.lastname: Testini
authors.forename: G
authors.initials: G
authors.lastname: Piccinni
authors.forename: G
authors.initials: G
authors.lastname: Urgesi
authors.forename: G
authors.initials: G
authors.lastname: Lissidini
authors.forename: N
authors.initials: N
authors.lastname: Tomasicchio
authors.forename: A
authors.initials: A
authors.lastname: Centonze
authors.forename: G M
authors.initials: GM
authors.lastname: Bonomo
mesh_terms: D003092:Colitis / Q000139:chemically induced / Q000175:diagnosis / Q000209:etiology; D003093:Colitis, Ulcerative / Q000175:diagnosis; D003424:Crohn Disease / Q000175:diagnosis; D003937:Diagnosis, Differential; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis*