title: Differential diagnosis in inflammatory bowel disease colitis: state of the art and future perspectives.
abstract: Distinction between Crohn's disease of the colon-rectum and ulcerative colitis or inflammatory bowel disease (IBD) type unclassified can be of pivotal importance for a tailored clinical management, as each entity often involves specific therapeutic strategies and prognosis. Nonetheless, no gold standard is available and the uncertainty of diagnosis may frequently lead to misclassification or repeated examinations. Hence, we have performed a literature search to address the problem of differential diagnosis in IBD colitis, revised current and emerging diagnostic tools and refined disease classification strategies. Nowadays, the differential diagnosis is an untangled issue, and the proper diagnosis cannot be reached in up to 10% of patients presenting with IBD colitis. This topic is receiving emerging attention, as medical therapies, surgical approaches and leading prognostic outcomes require more and more disease-specific strategies in IBD patients. The optimization of standard diagnostic approaches based on clinical features, biomarkers, radiology, endoscopy and histopathology appears to provide only marginal benefits. Conversely, emerging diagnostic techniques in the field of gastrointestinal endoscopy, molecular pathology, genetics, epigenetics, metabolomics and proteomics have already shown promising results. Novel advanced endoscopic imaging techniques and biomarkers can shed new light for the differential diagnosis of IBD, better reflecting diverse disease behaviors based on specific pathogenic pathways.
authors.affiliation: Gian Eugenio Tontini, Maurizio Vecchi, Luca Pastorelli, Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy.
authors.forename: Gian Eugenio
authors.initials: GE
authors.lastname: Tontini
authors.affiliation: Gian Eugenio Tontini, Maurizio Vecchi, Luca Pastorelli, Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Vecchi
authors.affiliation: Gian Eugenio Tontini, Maurizio Vecchi, Luca Pastorelli, Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Pastorelli
authors.affiliation: Gian Eugenio Tontini, Maurizio Vecchi, Luca Pastorelli, Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy.
authors.forename: Markus F
authors.initials: MF
authors.lastname: Neurath
authors.affiliation: Gian Eugenio Tontini, Maurizio Vecchi, Luca Pastorelli, Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy.
authors.forename: Helmut
authors.initials: H
authors.lastname: Neumann
mesh_terms: D003093:Colitis, Ulcerative / Q000175:diagnosis* / Q000628:therapy; D003424:Crohn Disease / Q000175:diagnosis* / Q000628:therapy; D003937:Diagnosis, Differential; D003938:Diagnostic Techniques, Digestive System; D006801:Humans; D011237:Predictive Value of Tests; D011379:Prognosis
keywords: Advanced endoscopic imaging; Biomarkers; Crohn’s disease; Histopathology; Inflammatory bowel disease unclassified; Ulcerative colitis