The Temporal Evolution of Histological Abnormalities in Microscopic Colitis

Background and Aims: Microscopic colitis (MC) is a common cause of chronic watery diarrhoea but long-term follow-up data are sparse. Methods: 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 po...

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Bibliographic Details
Published in:Journal of Crohn's and colitis 2016-03, Vol.10 (3), p.262-268
Main Authors: Rasmussen, Julie, Engel, Peter Johan Heiberg, Wildt, Signe, Fiehn, Anne-Marie Kanstrup, Munck, Lars Kristian
Format: Article
Language:English
Subjects:
Aged
Biopsy
Colitis, Microscopic - diagnosis
Colitis, Microscopic - epidemiology
Colitis, Microscopic - pathology
Colon - pathology
Denmark - epidemiology
Disease Progression
Female
Follow-Up Studies
Humans
Incidence
Intestinal Mucosa - pathology
Male
Middle Aged
Original
Retrospective Studies
Sensitivity and Specificity
Time Factors
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Summary:Background and Aims: Microscopic colitis (MC) is a common cause of chronic watery diarrhoea but long-term follow-up data are sparse. Methods: 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%) patients with CC, 200 (55%) with LC and 107 (47%) with MCi. The diagnostic sensitivities of both left- and right-sided biopsies for MC were 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 respectively within 1 year, while histology was normal in 16, 13 and 21%. Post-diagnostic biopsies were obtained in 283 patients. MC persisted for up to one year in 77% with CC, 64% with LC and 45% with MCi, of whom 6, 9 and 18% respectively changed to a different MC subgroup. Conclusions: 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.
ISSN:1873-9946
1876-4479
DOI:10.1093/ecco-jcc/jjv200