Non-specific colitis, is it a justifiable diagnosis?

The terms non-specific and chronic colitis are often used by histopathologists. The aim of this study is to look into the validity of the label non-specific chronic colitis (NSCC), the consistency of its reporting, as well as its clinical usefulness in patients who, on review, have shown to have normal biopsies.

Colonic and rectal biopsies from 35 patients who presented with acute onset diarrhoea, were initially diagnosed as nonspecific chronic colitis (NSCC) by a number of pathologists in one Department, and were reviewed by an outside pathologist (NYH) without the knowledge of the clinical details. A previously described set of histological criteria in reporting colonic biopsies in inflammatory conditions were used.

Normal biopsies were found in 13 of the 35 patients (37%). These patients recovered without clinical intervention. In a further seven patients there was active inflammation with no features of chronicity, in 12 patients there were features of chronicity, in two patients there were hyperplastic polyps, and in one patient there were features of solitary ulcer syndrome.

NSCC was used, without consistency, to cover a variety of conditions, including normal biopsies, sometimes relaying a wrong message. We suggest that histological criteria for chronicity should be adhered to when this label is used and the term Non-Specific Colitis should no longer be used.