Colonoscopic and Histopathological Findings in Patients with Various Lower Gastrointestinal Symptoms: A Single-Center Experience

Abstract

Background: Early diagnosis of lower gastrointestinal (GI) diseases constitutes a challenge. While colonoscopy helps in the detection of these diseases; histopathological analysis of obtained biopsies is of greater importance. Aim: This study aimed at the identification of colonic lesions associated with common lower GI manifestations based on colonoscopy and histopathological examination of biopsies. Materials and Methods: In a retrospective cross-sectional study, we included medical records of 710 patients involving their personal, clinical, endoscopic, and pathological data. Included data were of patients who presented with lower GI manifestations, and underwent colonoscopy and biopsy taking in the period from January 2016 to June 2020. Results: The most found pathology was non-specific chronic colitis (NSCC) (59.7%), followed by malignancy 19.3%) then inflammatory bowel disease (IBD) (15.6%), hyperplastic inflammatory polyp in 3.7%. Meanwhile, bilharzial colitis was diagnosed in 1.3% of patients. Significant predictors of both NSCC and malignancy were advanced age (<0.001), diabetes, hypertension, abdominal pain, diarrhea, and bloody diarrhea. In addition, bleeding per rectum and weight loss were also found to be specific predictors in malignancy. The only predictors of IBD were abdominal pain and bloody diarrhea and weight loss. Conclusions: NSCC, malignancy, and IBD are the most common causes of lower GI manifestations. Moreover, clinical predictors of these diseases are useful in the early diagnosis and management of colonic lesions.

Colonoscopy and Histopathologic Features in Chronic Diarrhea Patients at Dr. Hasan Sadikin General Hospital Bandung

“…Consistent with studies by Denis et al, Moussa et al, and Bhagyalakshmi et al, the malignancies were predominantly found in specific histopathology. 13,14,16 Our investigation also discovered that adenomatous polyp was found in 4% of the subjects. Based on colorectal cancer pathogenesis, the adenomatous polyp may develop into colorectal cancer.…”

“…In contrast with a study from Moussa et al, the majority of NSCC histopathology findings admitted due to chronic diarrhea accompanied by hematochezia. 14 Specific results from histopathologic findings in this study mainly were malignancy and inflammatory bowel disease (IBD). Consistent with studies by Denis et al, Moussa et al, and Bhagyalakshmi et al, the malignancies were predominantly found in specific histopathology.…”

“…10,13 Moussa et al stated that the difference might manifest in different patient characteristics and clinical manifestations, which affected colonoscopy findings. 14 This study discovered that colonoscopy features mostly found hyperemic edema, followed by ulceration. The biopsies showed that 59% of findings yielded nonspecific chronic colitis (NSCC).…”

“…The same patterns were also described by Moussa et al The colonoscopy results from Moussa et al study were mucosal inflammation with loss of normal vascular pattern (75.3%) and ulceration (17.7%). 14 Hyperemic edema is one sign of mucosal inflammation. Different results were reported by Bhagyalakshmi et al and Javier et al, the majority of colonoscopy findings were ulcerations.…”

“…Studies by Moussa et al and Bhagyalakshmi et al showed non-specific histological findings were more prominent in number than specific histological findings. 13,14 Bhagyalakshmi et al and Emara et al demonstrated that non-specific histological findings were affected by several factors. The expertise of the operator of both endoscopist and pathologist, the instruments, size of the samples, the timing for biopsy, and reference of the clinical data submitted to the pathologist, were the affecting factors.…”