Endoscopic diagnosis of chronic diarrhea

Abstract

The prevalence of chronic diarrhea in the general population is reported to be 4%–5%. Since various pathological conditions cause diarrheal symptoms, etiological diagnosis of chronic diarrhea is difficult in many cases. Medical history taking, physical examinations, and laboratory testing are not adequately sensitive or specific, thus a colonoscopic investigation is frequently employed for etiological evaluation. However, for cases with non‐bloody chronic diarrhea, the diagnostic yield of a colonoscopy procedure is reported to be not high enough. Furthermore, endoscopically identifiable findings are not adequately specific for the diagnosis of diarrheal disease, except for inflammatory bowel disease, while microscopic colitis, amyloidosis, eosinophilic gastroenteritis, celiac disease, and bile acid diarrhea are difficult to definitively diagnose using endoscopic findings. Thus, a histopathological examination of biopsy samples obtained with endoscopy is critically important. Endoscopists should consider obtaining biopsy samples from even normal‐appearing gastrointestinal mucosa for chronic diarrhea diagnosis.

Warning to Delay in Diagnosing Microscopic Colitis in Older Adults. A Series of Cases

“…The incidence of MC is increasing worldwide, therefore primary care professionals and/or gastroenterologists must be aware of this overlooked condition. More colonoscopies with biopsies to distinguish MC from IBS are necessary to increase diagnosis (2,3,7,27) .…”

“…Endoscopically, macroscopic changes are inconsistent or absent, therefore histopathological evaluation is always required for the diagnosis of MC. Therefore, endoscopists alerted by physicians, should consider obtaining fragments even when mucosa shows normal appearance as in the case of suspected microscopic colitis (MC) (2,3) .…”

A Gut-Wrenching Feeling: Overcoming Cognitive Biases in an Atypical Presentation of Chronic Mesenteric Ischemia

“…With the patient's unrevealing serologic evaluation, and GI evaluation questionable for ulcerative disease, a tentative diagnosis of inflammatory bowel disease was given. However, once the pathology results came back negative, we were left with no other known modalities of endoscopic evaluation of diarrheal diseases [ 6 , 11 ]. We then opted to repeat a CT scan with intravenous contrast revealing atherosclerotic disease burden [ 12 , 13 ] and this allowed us to discover that the patient was suffering from CMI.…”

Severe chronic diarrhoea caused by hereditary transthyretin amyloidosis

“…Apart from inflammatory bowel disease, there are no specific endoscopic findings that can be used to identify diarrhoeal diseases. Endoscopic findings in amyloidosis may include a fine granular appearance, erosions, ulcerations, mucosal friability and protrusions or lesions resembling tumours, although these findings are not pathognomonic 14. Definitive diagnosis is made through pathological examination, which involves Congo red staining and the observation of apple-green birefringence in positive samples.…”

“…Endoscopic findings in amyloidosis may include a fine granular appearance, erosions, ulcerations, mucosal friability and protrusions or lesions resembling tumours, although these findings are not pathognomonic. 14 Definitive diagnosis is made through pathological examination, which involves Congo red staining and the observation of apple-green birefringence in positive samples. Alternatively, mass spectrometry is also a highly useful method for amyloid typing, being more specific and sensitive than immunohistochemistry.…”