Anne-Marie Kanstrup Fiehn1,2, Stephan Miehlke3, Daniela Aust4, Michael Vieth5, Ole Bonderup6, Fernando Fernández-Bañares7, Emese Mihaly8, Juozas Kupcinskas9, Ahmed Madisch10, Lars Kristian Munck11,12, Tanju Nacak13, Ralf Mohrbacher13, Ralph Mueller13, Roland Greinwald13, Andreas Münch14. 1. Department of Pathology and Department of Surgery, Zealand University Hospital, Roskilde, Denmark. ankf@regionsjaelland.dk. 2. Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. ankf@regionsjaelland.dk. 3. Center for Digestive Diseases, Internal Medicine Center Eppendorf & Center for Esophageal Disorders, University Hospital Eppendorf, Hamburg, Germany. 4. Institute for Pathology, University Hospital Dresden, Dresden, Germany. 5. Institute for Pathology, Klinikum Bayreuth, Bayreuth, Germany. 6. Diagnostic Center, Silkeborg Hospital, Silkeborg, Denmark. 7. Department of Gastroenterology, Hospital Universitari Mútua Terrassa, Terrassa, Barcelona, and Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Terrassa, Spain. 8. 2nd Department of Internal Medicine, Semmelweis University, Budapest, Hungary. 9. Department of Gastroenterology and Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania. 10. Department of Gastroenterology, CRH Clinic Siloah, Hannover, Germany. 11. Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. 12. Department of Medical Gastroenterology, Zealand University Hospital, Koege, Denmark. 13. Dr. Falk Pharma GmbH, Freiburg, Germany. 14. Gastroenterology and Hepatology in Linköping, and Department of Health, Medicine, and Caring Sciences, Linköping University, Linköping, Sweden.
Abstract
PURPOSE: The diagnosis microscopic colitis (MC) consisting of collagenous colitis (CC) and lymphocytic colitis (LC) relies on histological assessment of mucosal biopsies from the colon. The optimal biopsy strategy for reliable diagnosis of MC is controversial. The aim of this study was to evaluate the distribution of histopathological features of MC throughout the colon. METHODS: Mucosal biopsies from multiple colonic segments of patients with MC who participated in one of the three prospective European multicenter trials were analyzed. Histological slides were stained with hematoxylin-and-eosin, a connective tissue stain, and CD3 in selected cases. RESULTS: In total, 255 patients were included, 199 and 56 patients with CC and LC, respectively. Both groups exhibited a gradient with more pronounced inflammation in the lamina propria in the proximal colon compared with the distal colon. Similarly, the thickness of the subepithelial collagenous band in CC showed a gradient with higher values in the proximal colon. The mean number of intraepithelial lymphocytes was > 20 in all colonic segments in patients within both subgroups. Biopsies from 86 to 94% of individual segments were diagnostic, rectum excluded. Biopsies from non-diagnostic segments often showed features of another subgroup of MC. CONCLUSION: Conclusively, although the severity of the histological changes in MC differed in the colonic mucosa, the minimum criteria required for the diagnosis were present in the random biopsies from the majority of segments. Thus, our findings show MC to be a pancolitis, rectum excluded, questioning previously proclaimed patchiness throughout the colon.
PURPOSE: The diagnosis microscopic colitis (MC) consisting of collagenous colitis (CC) and lymphocytic colitis (LC) relies on histological assessment of mucosal biopsies from the colon. The optimal biopsy strategy for reliable diagnosis of MC is controversial. The aim of this study was to evaluate the distribution of histopathological features of MC throughout the colon. METHODS: Mucosal biopsies from multiple colonic segments of patients with MC who participated in one of the three prospective European multicenter trials were analyzed. Histological slides were stained with hematoxylin-and-eosin, a connective tissue stain, and CD3 in selected cases. RESULTS: In total, 255 patients were included, 199 and 56 patients with CC and LC, respectively. Both groups exhibited a gradient with more pronounced inflammation in the lamina propria in the proximal colon compared with the distal colon. Similarly, the thickness of the subepithelial collagenous band in CC showed a gradient with higher values in the proximal colon. The mean number of intraepithelial lymphocytes was > 20 in all colonic segments in patients within both subgroups. Biopsies from 86 to 94% of individual segments were diagnostic, rectum excluded. Biopsies from non-diagnostic segments often showed features of another subgroup of MC. CONCLUSION: Conclusively, although the severity of the histological changes in MC differed in the colonic mucosa, the minimum criteria required for the diagnosis were present in the random biopsies from the majority of segments. Thus, our findings show MC to be a pancolitis, rectum excluded, questioning previously proclaimed patchiness throughout the colon.
Authors: Douglas K Rex; Philip S Schoenfeld; Jonathan Cohen; Irving M Pike; Douglas G Adler; M Brian Fennerty; John G Lieb; Walter G Park; Maged K Rizk; Mandeep S Sawhney; Nicholas J Shaheen; Sachin Wani; David S Weinberg Journal: Gastrointest Endosc Date: 2014-12-02 Impact factor: 9.427
Authors: F Magro; C Langner; A Driessen; A Ensari; K Geboes; G J Mantzaris; V Villanacci; G Becheanu; P Borralho Nunes; G Cathomas; W Fries; A Jouret-Mourin; C Mescoli; G de Petris; C A Rubio; N A Shepherd; M Vieth; R Eliakim Journal: J Crohns Colitis Date: 2013-07-17 Impact factor: 9.071
Authors: Andreas Münch; Emese Mihaly; Ferenc Nagy; Ahmed Madisch; Juozas Kupčinskas; Stephan Miehlke; Johan Bohr; Gerd Bouma; Jordi Guardiola; Blanca Belloc; Chunliang Shi; Daniela Aust; Ralf Mohrbacher; Roland Greinwald; Lars Kristian Munck Journal: United European Gastroenterol J Date: 2021-08-20 Impact factor: 6.866