alexa The temporal evolution of histologic abnormalities in microscopic colitis


Journal of Clinical & Experimental Pathology

Author(s): Julie Rasmussen, Peter Johan Heiberg Engel, Signe Wildt, AnneMarie Kanstrup Fiehn, Lars Kristian Munck

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Objective: Microscopic colitis (MC) is a common cause of chronic watery diarrhoea but long time follow up is sparse. We performed a retrospective review of health records and all pathology reports in a regional cohort of patients with MC to describe the change in pre- and post-diagnostic colon biopsies. Results: MC was diagnosed in 468 patients with collagenous colitis (CC), 361 with lymphocytic colitis (LC) and 226 with incomplete MC (MCi). The 2014 incidence of CC, LC and MCi was 14.5, 14.9, and 5 per 105. Biopsies from both right and left colon were obtained in 237 (51%) with CC, 200 (55%) with LC and 107 (47%) with MCi. The diagnostic sensitivity of both left and right sided biopsies for MC was high and did not differ. Pre-diagnostic biopsies were obtained in 150 patients and lamina propria inflammation was described in 59%, 47% and 43% of patients with a diagnosis of CC, LC and MCi within one year, while histology was normal in 16%, 13% and 21%. Post-diagnostic biopsies were obtained in 283 patients. MC persisted within the first year in 77% with CC, 64% with LC and 45% with MCi, and of whom 6%, 9% and 18% respectively changed to a different MC subgroup. Conclusion: Colonic biopsies obtained prior to the MC diagnosis often revealed increased lamina propria inflammation. The pathological changes of CC and LC are more persistent than those of MCi. Biopsies from the descending or sigmoid colon are sufficient to elucidate whether a patient with chronic watery diarrhoea has MC.

This article was published in Journal of Crohn's and Colitis and referenced in Journal of Clinical & Experimental Pathology

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