The histological diagnosis of dysplastic and neoplastic lesions in inflammatory bowel disease: a pathological perspective.

Patients with inflammatory bowel disease (IBD), both ulcerative colitis (UC) and Crohn's disease (CD), are at an increased risk for developing colorectal carcinoma (CRC). The accurate diagnosis of dysplasia in biopsies taken during periodic surveillance of long-standing IBD patients is most important in prevention of UC and CD related cancer. Distinction of low from high grade IBD-related dysplasia and differential diagnosis between IBD-related dysplasia and dysplasia in sporadic adenoma as well as distinction from pseudodysplastic lesions in inflammatory pseudopolyps or reparative lesions is often very subtle and difficult and demands expertise of second experienced gastrointestinal pathologist. Although surveillance colonoscopy with multiple biopsies does not reduce the cancer mortality, it offers a reasonable chance of detecting precancer and performed prophylactic colectomy. Novel methods of detecting dysplasia are continuously being evaluated, including chromoscopy and molecular biology markers. In the future, one may expect, from these new markers to detect the dysplasia in IBD patients before development of histological evidence of neoplastic changes.

[Premalignant and malignant changes in idiopathic inflammatory bowel disease]. / Premaligne i maligne promene u idiopatskim zapaljenskim crevnim bolestima.

It is well known that patients with long-standing inflammatory bowel disease (IBD), ulcerative colitis (UC) or Crohn's disease(CD) are at increased risk for developing colorectal cancer (CC). Before adenocarcinoma develops, the intestinal epithelium progress through a premalignant phase of dysplasia, which can be identified via mucosal biopsy and routine tissue histology. Surveillance colonoscopy and prophylactic colectomy for dysplasia or asymptomatic cancer is advised as a method of reducing cancer-related mortality. Many physicians suggests that surveillance for extensive colitis should begin after 8 to 10 years of disease, and surveillance for left-sided colitis should begin after 15-20 years. Colonoscopy is recommended with frequent biopsies, at least every 10 cm in all four quadrants, and with biopsy of any suspicious lesion. The emerging field of colon cancer genetics has identified several important tumor markers that have potential to improve sensitivity for detection of early neoplasia.

[Surgical treatment of Crohn disease of the small intestine]. / Hirursko lecenje Kronove bolesti tankog creva.

The evolution of the surgical treatment of Crohn's disease has three attainable aims: to be minimal, safe and therefore timely. Conservative surgery is increasingly the trend in surgical treatment of small-bowel Crohn's disease. Patients with Crohn's disease are managed non-surgically until complications of the disease or failure to thrive or significant side effects of medication occur, and then--at this point--surgery usually occurs. Once a complication has developed, it is not recommended to wait for this to become further complicated. Resectional surgery and strictureplasty for Crohn's disease of the small bowel are today methods of choice. Laparoscopic intestinal surgery is going to be of a great significance. Abdominal surgery for Crohn's disease is not curative and forms only part of a lifetime management of the patient.