Pattern-based histologic approach in colitis with chronic architectural damage: GIPAD recommendations

<h2>Abstract</h2> Histologic evaluation of colonic biopsies in patients with chronic diarrhea or long-standing colitis is frequently performed in the setting of incomplete clinical, endoscopic, or laboratory information. In this context, overlapping morphologic features across different etiologies often lead to nonspecific or misleading diagnoses, such as "chronic colitis," with potential implications for patient management. To improve diagnostic clarity and clinicopathologic communication, the Italian Group of Digestive Disease Pathology (GIPAD) developed a structured, pattern-based histologic approach for the interpretation and reporting of adult colitis with chronic architectural damage, based on multidisciplinary discussion and critical appraisal of the literature. Distinct histologic patterns are described and correlated with relevant differential diagnoses. Major patterns of colitis with chronic architectural damage are identified, and for each pattern, key morphologic features and principal differential diagnoses—including inflammatory bowel disease and other conditions such as drug-related injury, ischemia, infection, diversion colitis, and immune-mediated disorders—are discussed. A pattern-based histologic approach provides a practical framework for reporting colitis with chronic architectural damage. This strategy narrows differential diagnoses, avoids nonspecific terminology, and supports clinical decision-making, while preserving the primacy of integrated clinicopathologic diagnosis when sufficient information is available.

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Publication Details

Journal
Digestive and Liver Disease
Published
2026-05-01
DOI
https://doi.org/10.1016/j.dld.2026.04.003
Primary Topic
Microscopic Colitis
Type
article
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article

Pattern-based histologic approach in colitis with chronic architectural damage: GIPAD recommendations

Luca Albarello, Federica Grillo, Tiziana Salviato, P. Parente et al.
Digestive and Liver Disease
Microscopic Colitis
article

Pattern-based histologic approach in colitis with chronic architectural damage: GIPAD recommendations

Luca Albarello, Federica Grillo, Tiziana Salviato, P. Parente, Valentina Angerilli, Luca Savino, Roberta Gafà, Francesca Rosini, Matteo Fassan, Giovanni Arpa, Luca Mastracci, Maria Cristina Macciomei, Paola Spaggiari, Iacopo Panarese, Davide Giuseppe Ribaldone, Alessandro Caputo, Luca Reggiani Bonetti, Gianmaria Pennelli, Edoardo Vincenzo Savarino, Alesandro Vanoli
article en

Abstract

<h2>Abstract</h2> Histologic evaluation of colonic biopsies in patients with chronic diarrhea or long-standing colitis is frequently performed in the setting of incomplete clinical, endoscopic, or laboratory information. In this context, overlapping morphologic features across different etiologies often lead to nonspecific or misleading diagnoses, such as "chronic colitis," with potential implications for patient management. To improve diagnostic clarity and clinicopathologic communication, the Italian Group of Digestive Disease Pathology (GIPAD) developed a structured, pattern-based histologic approach for the interpretation and reporting of adult colitis with chronic architectural damage, based on multidisciplinary discussion and critical appraisal of the literature. Distinct histologic patterns are described and correlated with relevant differential diagnoses. Major patterns of colitis with chronic architectural damage are identified, and for each pattern, key morphologic features and principal differential diagnoses—including inflammatory bowel disease and other conditions such as drug-related injury, ischemia, infection, diversion colitis, and immune-mediated disorders—are discussed. A pattern-based histologic approach provides a practical framework for reporting colitis with chronic architectural damage. This strategy narrows differential diagnoses, avoids nonspecific terminology, and supports clinical decision-making, while preserving the primacy of integrated clinicopathologic diagnosis when sufficient information is available.

Digestive and Liver Disease
University of Modena and Reggio Emilia (IT), AOL (United States) (US), University of Salerno (IT), University of Padua (IT), University of Ferrara (IT), University of Pavia (IT), Ospedali Riuniti di Foggia (IT), Azienda Ospedaliera San Camillo-Forlanini (IT), AULSS 2 Marca Trevigiana (IT), Azienda Unità Sanitaria Locale di Ferrara (IT), Istituto Oncologico Veneto (IT), Azienda USL di Bologna (IT), Arcispedale Sant'Anna (IT), Azienda Ospedaliera Universitaria Università degli Studi della Campania Luigi Vanvitelli (IT), IRCCS Ospedale San Raffaele (IT), Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale" (IT), Ospedale Policlinico San Martino (IT), Azienda Ospedale - Università Padova (IT), Ospedale SS. Annunziata (IT), Policlinico San Matteo Fondazione (IT), Istituti di Ricovero e Cura a Carattere Scientifico (IT), IRCCS Humanitas Research Hospital (IT), University of Turin (IT), University of Genoa (IT)
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Openalex Percentile: Top 5%
Microscopic Colitis
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