Endoscopy has an essential role in the diagnosis, assessment of inflammatory activity, and follow-up of IBD. It allows direct visualization of mucosal lesions, which can range from simple erosions to deep ulcerations, inflammatory pseudopolyps, or strictures.

In addition, histological examination, which complements endoscopy, is crucial for confirming the diagnosis and differentiating IBD from other inflammatory or neoplastic diseases of the colon.

The aim of this study is to analyze the endoscopic and histological aspects of colorectal lesions observed in patients with IBD.

This is a retrospective descriptive study conducted between January 2023 and January 2025 in the Hepatology, Gastroenterology, and Proctology Department (Medicine B) at Ibn Sina Hospital - Ibn Sina University Hospital.

We included all patients aged over 16 years old who were being treated for chronic inflammatory bowel diseases, namely Crohn's disease and ulcerative colitis, and who had undergone ileocolonoscopy with staged colorectal biopsies.

Patients with incomplete data or normal colonoscopies were excluded from our study.

We included 75 cases of IBD collected over a period of 2 years, including 40 cases of Crohn's disease and 35 cases of ulcerative colitis.

Among patients with Crohn's disease, the average age was 38.5 years, ranging from 18 to 72 years, and the sex ratio (M/F) was 0.4.

Ulcerations were found in 40% of cases (including aphthoid ulcerations in 53% of cases, superficial linear ulcerations in 35% of cases, and deep ulcerations in 12% of cases), pseudopolyps in 21% of cases,  a sessile polyp in 14% of cases, a pedunculated polyp in 4% of cases, stenosis in 16.5% of patients, and colonic erythema in 4.5% of cases.

Histological examination revealed: nonspecific interstitial colitis in 48.5% of cases, subacute colitis in 35% of cases, granuloma without caseous necrosis in 5.5% of cases, subacute proctitis in 5.5%, and interstitial proctitis in 5.5%.

Among patients with UC, the average age is 45 years and the sex ratio (M/F) is 0.54.

Ulcerations were found in 20% of cases, pseudopolyps in 42.5% of cases, a sessile polyp in 20% of cases, a pedunculated polyp in 5.5% of cases, colic erythema in 6% of patients, and erosions in 6% of cases. In addition, the vascular pattern disappeared in 16 cases, partially disappeared in 5 cases, and remained intact in 4 cases.

Histological examination revealed: nonspecific interstitial colitis in 57% of cases, subacute colitis in 20% of cases, subacute proctitis in 23% (of which 70% was ulcerative proctitis and 30% was non-ulcerative).

Ulcerations are the most common lesions in Crohn's disease, while pseudopolyps and polyps are more common in ulcerative colitis. Thus, there is a predominance of nonspecific interstitial colitis and subacute colitis in both diseases.

Our study highlights the distinct endoscopic and histological features of CD and UC, which are essential for the diagnosis and follow-up of patients.