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Increased subepithelial collagen deposition is not specific for collagenous colitis
H H Wang1, D V Owings, D A Antonioli
1Department of Pathology, Beth Israel Hospital, Boston, Massachusetts.
Summary
Increased subepithelial collagen deposition (SCD) is not exclusive to collagenous colitis (CC). Greater amounts of SCD correlate with a higher likelihood of watery diarrhea, suggesting quantity matters more than presence.
Area of Science:
- Gastroenterology
- Pathology
- Histology
Background:
- Collagenous colitis (CC) is characterized by subepithelial collagen deposition (SCD).
- The specificity of increased SCD for CC diagnosis requires further investigation.
Purpose of the Study:
- To refine the pathologic diagnosis of collagenous colitis.
- To determine if increased subepithelial collagen deposition (SCD) is specific for collagenous colitis (CC).
Main Methods:
- Review of 1549 colonic mucosal biopsies and 157 resections.
- Quantitative evaluation of SCD thickness and surface area involvement.
- Correlation of histologic findings with clinical features, particularly watery diarrhea.
Main Results:
- Increased SCD (≥5 microns) was found in 1.7% of biopsies and 7% of resections.
- Six biopsy patients (27%) with unexplained watery diarrhea showed significantly greater SCD amounts.
- Increased SCD without diarrhea was primarily observed in rectal and rectosigmoid samples.
Conclusions:
- Increased subepithelial collagen deposition (SCD) is not specific for collagenous colitis (CC).
- The quantity of SCD, not merely its presence, is crucial for diagnosis.
- Greater amounts of SCD are associated with an increased probability of watery diarrhea.