Specific histological abnormalities are more likely in biopsies of endoscopically normal large bowel after the age of 60 years

O'Mahony, Orla; Burgoyne, Margaret; Going, James J.

doi:10.1111/j.1365-2559.2012.04317.x

Cited by 7 publications

(6 citation statements)

References 9 publications

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“…This rate is predictably similar to that found in a recent study, which detected abnormal histology in 11% of specimens from colorectal biopsies of patients with normal endoscopy and without diarrhea [10]. Furthermore, this rate is predictably much less than that found in a previous study, which detected abnormal histology in 32.1% of patients with normal colonoscopy and with chronic diarrhea [11].…”

Section: Discussionsupporting

confidence: 88%

Specimens from Biopsies of Colorectal Polyps Often Harbor Additional Diagnoses

Chopra

2013

Pathology Research International

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Objectives. The utility of examining specimens from colorectal biopsies of polyps for nonneoplastic diseases is currently unknown. Our objectives were to characterize such additional diagnoses that could be rendered. Methods. We retrospectively and prospectively reviewed specimens from endoscopic biopsies of colorectal polyps obtained during routine screening or surveillance. Results. 17 of 168 specimens (10.1%) contained additional diagnoses, including schistosomiasis, eosinophilic colitis, intestinal spirochetosis, melanosis coli, and other entities. These findings were easily overlooked because they often affected mucosa that was spared by the polyps or were often evident only at high magnification. Schistosomiasis, eosinophilic colitis, and intestinal spirochetosis were clinically occult. Conclusions. Specimens from biopsies of colorectal polyps often harbor other diagnoses, in addition to polyps, and can be simultaneously screened for polyps and examined for nonneoplastic diseases. Detection of other diagnoses in addition to polyps requires awareness, examination at high magnification, and examination of areas spared by the polyps.

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Section: Discussionsupporting

confidence: 88%

Specimens from Biopsies of Colorectal Polyps Often Harbor Additional Diagnoses

Chopra

2013

Pathology Research International

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“…Biopsies of endoscopically normal large‐bowel mucosa are generally believed to yield little information. As has recently been shown in a large retrospective analysis, which involved >600 subjects, a history of diarrhoea does not in itself identify patients at higher risk of abnormal histology (14.5% versus 11%; P = 0.41). Patients aged >60 years, however, have a markedly increased likelihood of having a specific histological abnormality as compared with younger patients [odds ratio 2.76; 95% confidence interval (CI) 1.30–5.79; P = 0.0045], and microscopic colitis is the most common diagnosis.…”

Section: Introductionmentioning

confidence: 80%

Histology of microscopic colitis—review with a practical approach for pathologists

et al. 2015

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Microscopic colitis has emerged as a major cause of chronic watery non-bloody diarrhoea, particularly in elderly females. The term is used as an umbrella term to categorize a subgroup of colitides with distinct clinicopathological phenotypes and no significant endoscopic abnormalities. Lymphocytic colitis is defined by an increased number of surface intraepithelial lymphocytes, and collagenous colitis by a thickened collagen band underneath the surface epithelium. There is increased inflammation in the lamina propria, but only little or no crypt architectural distortion. Incomplete and variant forms showing less characteristic features have been reported under different names. The differential diagnosis mainly includes resolving infectious colitis and changes related to the intake of drugs such as non-steroidal anti-inflammatory drugs. Substantial clinical and histological overlap between lymphocytic and collagenous colitis has been described, raising the suspicion that the conditions are two histological manifestations of the same entity, possibly representing different manifestations during the disease course or different stages of disease development. In this review, we provide a practical approach for pathologists, with a focus on diagnostic criteria and differential diagnosis, and discuss recent insights into the pathogenesis of disease and the relationship with classic chronic inflammatory bowel disease, i.e. Crohn's disease and ulcerative colitis.

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“…The key histological feature of CC is a thickened collagen band under the surface epithelium. 55 , 56 The European consensus guidelines on diagnosis state that the thickness of the collagen band should exceed 10 μm (normal <3 μm) in well-oriented biopsies (cut perpendicularly to the mucosal surface). 55 The band can appear thicker (up to 70 μm) and band thickness greater than 15mm is usually associated with diarrhea, 57 but there is no direct correlation between band thickness and symptoms.…”

Section: Collagenous Colitismentioning

confidence: 99%

Optimal management of collagenous colitis: a review

O’Toole¹

2016

CEG

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Collagenous colitis (CC) is an increasingly recognized cause of chronic inflammatory bowel disease characterized by watery non-bloody diarrhea. As a lesser studied inflammatory bowel disease, many aspects of the CC’s natural history are poorly understood. This review discusses strategies to optimally manage CC. The goal of therapy is to induce clinical remission, <3 stools a day or <1 watery stool a day with subsequent improved quality of life (QOL). Antidiarrheal can be used as monotherapy or with other medications to control diarrhea. Budesonide therapy has revolutionized treatment and is superior to prednisone, however, the treatment is associated with high-relapse rates and the management of refractory disease is challenging. Ongoing trials will address the safety and efficacy of low-dose maintenance therapy. For those with refractory disease, case reports and case series support the role of biologic agents. Diversion of the fecal stream normalizes colonic mucosal changes and ileostomy may be considered where anti-tumor necrosis factor (TNF)-α agents are contraindicated. Underlying celiac disease, bile salt diarrhea, and associated thyroid dysfunction should be ruled out. The author recommends smoking cessation as well as avoidance of nonsteroidal anti-inflammatories as well as other associated medications.

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Specific histological abnormalities are more likely in biopsies of endoscopically normal large bowel after the age of 60 years

Cited by 7 publications

References 9 publications

Specimens from Biopsies of Colorectal Polyps Often Harbor Additional Diagnoses

Specimens from Biopsies of Colorectal Polyps Often Harbor Additional Diagnoses

Histology of microscopic colitis—review with a practical approach for pathologists

Optimal management of collagenous colitis: a review

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