Inflammatory bowel disease (IBD), comprising ulcerative colitis (UC) and Crohn's disease (CD) are idiopathic relapsing, lifelong chronic conditions of the gastrointestinal tract which may also affect extraintestinal organs and tissues with sometimes devastating effects on the patient's quality of life. They share many common features; however, they may differ in their clinical manifestations and the way they affect the bowel. The questions that remain unanswered refer to whether they are two completely different diseases or two manifestations of one disease process with a very wide spectrum. If they are two separate entities, would the presence of one disease process preclude the presence of the other in the same patient?

UC mainly affects the large intestine starting distally, usually in the rectum, and spreads proximally in a continuous fashion. This is in contrast to CD, which classically affects the small bowel, but in the colon the involvement is classically discontinuous. However, CD can involve any part of the gastrointestinal tract from the mouth to the anus and both diseases can exhibit extra-intestinal manifestations affecting the skin, joints and the eyes. This chapter will briefly discuss the epidemiology, genetics, patho-genesis, and pathology of IBD but will mainly address the pathologist's approach in reporting these conditions.

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