Efficacy of endoscopic biopsies in the differention between different types of colitis. [a retrospective and prospective study]

ABSTRACT

This study was undertaken on 80 cases of colitis and 5 control cases. The study subjects were subdivided into 2 groups [GI] included 50 consecutive patients from Division of Gastroenterology, Department of Medicine. They were subjected to detailed history taking, thorough clinical examination, stool analysis, colonoscopy and biopsy. [GII] included 30 retrospective cases collected from the files of Pathology department. All specimens were subjected to routine histopathological examination. They were classified into Schistosomal colitis [26 cases -32.5%], amaebic colitis [16 cases - 20%], acute self limited colitis [ASLC] [3 cases - 3.75%], Crohn's disease [CD] [11 cases - 13.75%], chronic ulcerative colitis [CUC] [14 cases - 17.5%], collagenous colitis [one case - 1.25%] and colitis with non-specific pathologic changes [9 cases - 11.25%]. For CD, skip lesions and cobblestones were the main diagnostic endoscopic findings which were detected in 5 cases only, while the diffuse wet glaring mucosa from blood, mucus were the main findings in UC and ASLC. Microscopically, maintenance of glands architecture with persevered goblet cell population despite heavy deposition of the lamina propria by inflammatory cells mainly histiocytes that extended into the submucosa were the main diagnostic points of CD. While glands destruction and atrophy associated with cryptitis and inflammatory infiltrates mainly plasma cells were the main features of CUC. In cases of ASLC, history of acute colitis associated with preserved gland architecture, edema and inflammatory infiltrate mainly PNL that localized predominantly in the lower half of the mucosa were the main features. For collagenous colitis, chronic watery diarrhea with microscopic detection of subepithelial layer of collagen were the diagnostic signs. Accordingly we could conclude that proper diagnosis of colitis and subsequently proper management could be reached in almost every case with colitis but it rests on clinical, endoscopic, and pathological correlation provided that full colonoscopic examination was undertaken and sufficient number of biopsies of full thickness mucosa and at least part of the submucosa were taken from the proper sites