Natural history

With time, 50-72% of adult patients and 64% of pediatric patients with indeterminate colitis can be reclassified as having definite ulcerative colitis or Crohn's disease during subsequent obser-vation3-4,9-11,22 (Table 24.3). After a mean follow-up period of 14 months, one group reported that 33% of 36 patients with indeterminate colitis were reclassified as ulcerative colitis and 17% as Crohn's disease.9 Meucci et al reported that 37 of 50 patients (74%) changed from indeterminate colitis to a definite diagnosis of ulcerative colitis or Crohn's disease during follow-up with a cumulative probability of 80% within 8 years of diagnosis.10 In contrast, Wells et al followed 16 patients with indeterminate colitis for a mean of 10 years and observed that three were reclassified with ulcerative colitis, one with Crohn's disease and the rest remained indeterminate.11 The course of indeterminate colitis in 36 Swedish children after a mean follow-up of 4.6 years was analyzed by Hildebrand et al.3 The findings were similar to

Table 24.3 Indeterminate colitis (IC): changes in diagnosis with time

Diagnosis

Table 24.3 Indeterminate colitis (IC): changes in diagnosis with time

Diagnosis

Initial

Final

Final

Final

IC

IC (%)

UC (%)

CD (%)

Hildebrand et al3

36 (pediatric)

36

58

6

Moum et al9

36 (adult)

50

33

17

Meucci et al10

50 (adult)

20

34

40

Kangas et al22

6 (surgery)

50

50

Wells et alii

16 (surgery)

75

19

6

Gupta et al4

12 (surgery/pediatric)

33

50

17

UC, ulcerative colitis; CD, Crohn's disease

UC, ulcerative colitis; CD, Crohn's disease those as described above in adults: 21/36 (58%) were subsequently categorized as ulcerative colitis, 2/36 (6%) as Crohn's disease and 13/36 (36%) remaining as indeterminate colitis. In our report describing 49 children with indeterminate colitis, nine had undergone colectomy at a mean of 24 months after diagnosis. During a mean follow-up period of 42 months, 6/9 (66%) had a subsequent course, including repeat endoscopic examination consistent with ulcerative colitis, 3/9 (33%) as indeterminate colitis and 1/9 (11%) as Crohn's disease.

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