Simple Mucosal Biopsy Criteria Differentiating among Crohn Disease, Ulcerative Colitis, and Other Forms of Colitis: Measurement of Validity

Abstract

Recently established mucosal biopsy criteria reliably differentiate idiopathic inflammatory bowel disease (IBD) from other forms of colitis (non-IBD), and Crohn disease involving the colon (CD) from ulcerative colitis (UC) but were inconvenient in practical use because of the need for relatively complicated calculations. Our objectives were to establish simple criteria in which calculation could be done in the user's head and to measure their validity. On the basis of the above original criteria, we constructed two sets of criteria in which coefficients and constants were simplified to integral numbers. The first set of criteria consisted of the diagnostic categories 'definite IBD', 'probable IBD', 'unknown', 'probable non-IBD', and 'definite non-IBD'. Similarly, the second set had five categories from 'definite CD' to 'definite UC'. The validity of the criteria was evaluated in 117 patients with CD, 125 with UC, and 484 with non-IBD. In categories of probable IBD and probable non-IBD both sensitivity and specificity exceeded 96.3%. Probable CD and probable UC showed sensitivities of 95.7% and 92.0% and specificities of 93.6% and 98.3%. Despite simplified coefficients and constants, the validity appeared to be high enough to apply the present criteria to routine work.