Is It Really Colitis?

Abstract

Histologically normal or near-normal colonic biopsies from patients with diarrhea make up a significant proportion of routine gastrointestinal biopsy cases. Recognizing and reporting these biopsies as normal is important, because it facilitates diagnosis and management of patients presumed to have irritable bowel syndrome. There are a number of trivial and/or iatrogenic deviations from normal found in colorectal biopsies. These must be separated from true disease or inaccurate, meaningless, or even harmful biopsy reports could be issued. The differential diagnosis for patients with chronic diarrhea includes the microscopic colitides. Although the typical features of lymphocytic and collagenous colitis are familiar to most pathologists, some cases of microscopic colitis have atypical features that could obscure the correct diagnosis.A 42-year-old woman reported recurring episodes of abdominal pain and nonbloody diarrhea for the past year, recently increasing in frequency. Full colonoscopy was performed. At colonoscopy, a few aphthous-like lesions were seen; colonoscopy was otherwise normal. Biopsies of the right and left colon, to include aphthoid lesions, were performed.

Colonic mucosal eosinophilia and immunohistochemical expression of COX-2 and NF-kB in patients with irritable bowel syndrome

“…the mucosa appears grossly normal or near-normal [36,37]. The remaining 60 biopsy specimens (75%) had few mixed inflammatory cells such as eosinophil, lymphocyte, plasma cell and/or macrophage and this agreed with many studies reporting that no or few inflammatory cells could be seen in the colonic mucosa of most colonic biopsies taken from IBS patients [38,39]. We found that patients with IBS-D subtype showed a significantly higher incidence of colonic mucosal eosinophilic infiltration when compared to IBS-C (P = 0.049).…”