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Chronic, unexplained diarrhea: are biopsies necessary if colonoscopy is normal?
J B Marshall1, R Singh, A A Diaz-Arias
1Department of Internal Medicine, University of Missouri School of Medicine, Columbia.
The American Journal of Gastroenterology
|March 1, 1995
Summary
Biopsies from normal-appearing colons in chronic diarrhea patients rarely reveal significant issues. Clinically important abnormalities are infrequent, suggesting biopsies may be reserved for severe or specific symptom profiles.
Area of Science:
- Gastroenterology
- Histopathology
Background:
- Chronic unexplained diarrhea poses a diagnostic challenge.
- Macroscopic evaluation of the colon via endoscopy can appear normal despite underlying pathology.
Purpose of the Study:
- To determine the frequency of significant histological abnormalities in patients with chronic diarrhea and normal-appearing colonic endoscopies.
Main Methods:
- 111 patients with unexplained diarrhea and normal colonoscopies underwent biopsy.
- Biopsies were blindly reviewed by a pathologist.
Main Results:
- No cases of Crohn's disease, ulcerative colitis, collagenous colitis, or lymphocytic colitis were definitively diagnosed.
- Minor findings included possible collagenous colitis, features of lymphocytic colitis, melanosis coli, cytomegalovirus colitis, and radiation injury.
- The majority of cases showed no pathological diagnosis or minimal histological change.
Conclusions:
- The diagnostic yield of colonic biopsies in patients with macroscopically normal endoscopies for diarrhea is low.
- Biopsies may be more beneficial for patients with severe symptoms, "organic" diarrhea features, or immunosuppression.
- Recommendations are provided for optimizing biopsy collection to minimize costs.