"Clinical Correlation Suggested": How to Handle Discrepancies Between Clinical and Pathologic Findings in Inflammatory GI Biopsies

SOCIETY: AGA This symposium focuses on frustrating scenarios where histopathologic examination of inflammatory gastrointestinal tract biopsies shows findings that do not match a patient's clinical scenario or provide a challenging differential diagnosis. Gastroenterologists will present case-based clinical evaluation/endoscopic findings, and paired gastrointestinal pathologists will present pathologic findings on three different topics, to emphasize joint problem-solving to arrive at a final diagnosis and optimize patient management. The first topic will cover celiac disease and its mimics. The speakers will illustrate the art of communication between clinicians and pathologists to confirm the diagnosis of celiac disease, diagnose its complications, and prompt an alternative differential diagnosis using real and challenging cases. The second topic will cover challenging enterocolitis cases where the diagnosis is not what it initially appears to be. The third topic will cover pouchitis. In inflammatory bowel disease, the presence of histologic activity in a pouch may be challenging to appropriately interpret and manage. The speakers will discuss the clinical significance of histologic activity in an endoscopically normal pouch, as well as expand on the difficulties in distinguishing the presence of recurrent inflammatory bowel disease in the pouch from other inflammatory processes.