Crypts in Asymmetric Branching in Patients With Ulcerative Colitis in Remission

Abstract

Background/Aim: To report the frequency of crypts in asymmetric branching (CAB) in biopsies from all colorectal segments in patients with ulcerative colitis in remission (UCR). Patients and Methods: Biopsies in 100 UC patients were investigated: 50 with UCR and 50 with ongoing long-lasting UC (LLU; i.e., controls). Results: The frequency of CAB was significantly lower in UCR than in LLUC, both in the right colon and left colorectum. CAB frequency was not influenced by two important confounders: the age and sex of patients. Conclusion: CAB is a pathologic aberration of colorectal cryptogenesis evoked by chronic mucosal inflammation. When chronic inflammation waned in UCR, the production of CAB plummeted or ceased. Chronic inflammation and protracted disease-duration in LLUC increase the risk for colorectal dysplasia or carcinoma. Importantly, dysplastic CAB were recently detected in LLUCassociated dysplasia. Whether the abrogation of CAB is instrumental in reducing the neoplastic risk in UCR patients, deserves further investigation.In patients with ulcerative colitis (UC), colorectal endoscopic biopsies show, in addition to increased numbers of inflammatory cells, crypts with architectural distortions and branching crypts (1, 2). Crypt-branching in rectal biopsies from patients with UC was first mentioned by Morson in 1972 (3). Subsequently, Cheng et al. (4) found high