Clinical and endoscopic appraisal of these patients was done by an experienced gastroenterologist the biopsy materials were consensually reviewed by 2 gastrointestinal pathologists without the knowledge of the patients' clinical or endoscopic findings. The original study group consisted of 75 patients (Alexandra and National University Hospitals, Singapore) who had undergone colonoscopy for chronic diarrhea (defined as 3 or more loose motions a day for more than 1-month duration 13) between August 2002 and March 2005. On purely pathologic grounds, the characterization of those specific histomorphologic and immunohistologic features associated with chronicity would increase the biological understanding and the diagnostic accuracy of the disease. Although diarrhea in some of these patients is “self-limiting and resolving,” 2 in other cases it is “prolonged and unresolved.” 3 Many times patients with prolonged and unresolved diarrhea and nonspecific histologic changes are misdiagnosed as having irritable bowel syndrome 1, 3 or “minimal colitis.” 4 Clinically, the distinction between these 2 groups of patients has implications for their counseling and clinical management. Despite the inability of the pathologist to characterize these cases further, there are important clinical implications. Histologic changes in colonic biopsy materials from patients suffering of diarrhea are often reported by pathologists as “near-normal,” “nonspecific changes,” “within normal limits” or “mild, nonspecific inflammation.” 1 This group represents, arguably, the commonest diagnostic label in endoscopic colorectal pathology. The increased number of mast cells and paucity of Treg cells further helps to identify such unresolved cases. 01 respectively).Ĭonclusions.-Lymphocytic follicles and aggregates colitis, previously regarded as of negligible diagnostic significance, allows the prediction of the behavior of chronic diarrhea in a subset of patients with nonspecific changes on colonic biopsy. The number of mast cells and Treg cells showed significant difference between resolved and unresolved cases ( P =. 38), and total lymphoid follicles and aggregates per biopsy ( P =. 43), density of lymphoid follicles and aggregates ( P =. 48), number of total lymphoid follicles and aggregates ( P =. The duration of diarrhea was correlated with the number of large lymphoid follicles and aggregates ( P =. Results.-Increased number of lymphoid follicles and aggregates, increased number of mast cells, and paucity of Treg were the statistically significant key findings ( P =. Immunohistochemistry to mast cells (CD117) and Treg cells ( FOXP3) was also assessed in 39 patients. Objective.-To find, within this group, histologic and immunohistologic diagnostic criteria to predict the duration and resolution of diarrhea.ĭesign.-Detailed clinical features and histologic findings were analyzed in a cohort of 47 patients with chronic diarrhea, with near-normal histology and no clear-cut known etiologic agent. Context.-Nonspecific changes (nonspecific chronic inflammation) in patients with chronic diarrhea represent the commonest diagnosis in colorectal biopsy interpretation, but these changes are of little clinical significance.
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