克罗恩病与胃肠结核的组织学鉴别：IAPM-ISG-CCFI联合工作组建议
印度病理学家与微生物学家协会、印度胃肠病学会及印度结肠炎与克罗恩病基金会联合工作组，针对回盲部及结肠溃疡狭窄性病变中克罗恩病与胃肠结核的鉴别难题，采用结构化德尔菲流程制定组织学采样、判读与报告建议，旨在标准化病理实践、提高报告一致性并避免误诊误治。
要点
- 回盲部及结肠溃疡狭窄性病变需重点鉴别克罗恩病与胃肠结核。
- 建议标准化黏膜活检的采样、处理与判读流程。
- 多学会联合推荐旨在提高病理报告一致性与诊断信心。
核心结论
- 多学会专家基于证据制定的实用建议，旨在促进病理报告的一致性与信心，便于及时患者管理并防止错误治疗导致的并发症。
研究设计与样本
- 由IAPM、ISG和CCFI提名的核心专家协作制定建议，采用结构化德尔菲流程，经三次虚拟小组会议、多次在线投票和一次全体专家实体会议形成推荐。
主要发现
- 推荐意见基于专家组的讨论、头脑风暴和广泛文献综述形成。
关键数值与推荐
- 文件针对病理学家就克罗恩病与胃肠结核鉴别的优化活检方案、组织学判读和报告提出综合建议。
临床怎么用
- 该文件预期通过为初学专科医师和病理学家提供现成参考，标准化腔内胃肠病学实践，促进实践一致性。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
Indian J Gastroenterol. 2026 Jun;45(3):422-440. doi: 10.1007/s12664-026-01973-x. Epub 2026 Apr 11. ABSTRACT BACKGROUND: The most common causes for ulcero-stricturing diseases of the ileo-cecal region and colon in Southeast Asia are Crohn's disease (CD) and gastrointestinal tuberculosis (GI TB). Diagnosing these conditions is challenging because they share several clinical, endoscopic, radiological and histological features on mucosal biopsies. Therefore, there is a need to standardize the sampling, processing and interpretation of mucosal biopsies to aid clinical decision-making. METHODS: Recognizing this challenge, core subject experts nominated by the Indian Association of Pathologists and Microbiologists (IAPM), the Indian Society of Gastroenterology (ISG) and the Colitis and Crohn's Foundation, India (CCFI), collaborated to formulate comprehensive recommendations for pathologists regarding optimal biopsy protocols, histological interpretation and reporting for differentiating CD from GI TB. A structured Delphi process was followed. RESULTS: The recommendations from the core domain expert groups were based on discussions, brainstorming sessions and extensive literature reviews conducted over three virtual group meetings, multiple online voting sessions and one physical meeting involving all experts. This document is expected to standardize the practice of luminal gastroenterology by providing a ready reference for budding specialists and pathologists, thereby promoting uniformity in practice. CONCLUSION: These multi-society, evidence-based and practically applicable recommendations developed by core subject experts aim to promote uniformity and confidence in pathology reports, facilitate timely patient management and prevent complications arising from erroneous treatment. PMID: 41965448 | DOI: 10.1007/s12664-026-01973-x
引用
- 指南共识 · 支气管扩张与结核：Histological approach and differentiation of Crohn's disease and gastrointestinal tuberculosis: Recommendations from the joint IAPM-ISG-CCFI Working Group
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。