Document Detail

Microscopic colitis as a missed cause of chronic diarrhea.
MedLine Citation:
PMID:  21528078     Owner:  NLM     Status:  MEDLINE    
AIM: To determine the prevalence of increased intraepithelial lymphocytes, using immunohistochemistry in patients with normal colonoscopy and near normal biopsy.
METHODS: We retrospectively reviewed all non-malignant colon mucosal biopsies between 2005 and 2007, reported as normal, chronic inflammation or melanosis coli in patients who were undergoing routine colonoscopy. Immunohistochemistry using CD3 was performed on all mucosal biopsies and an intraepithelial lymphocyte count (IEL) was determined. Cases with an IEL count of ≥ 20 IELs per 100 surface epithelial cells were correlated with demographic, clinical and follow-up data. A further subgroup was evaluated for lymphocytic colitis.
RESULTS: Twenty (8.3%) of 241 cases revealed an IEL count ≥ 20. Six (2.5%) patients were identified as having lymphocytic colitis (P < 0.001), of whom, five were missed on initial evaluation (P = 0.01). Four of these five patients were labeled with diarrhea-predominant irritable bowel syndrome (IBS). On follow-up, three of the remaining 20 cases were diagnosed with malignancy (renal cell carcinoma and myelodysplastic syndrome) and one had an unknown primary tumor with multiple liver metastases. Two cases of collagenous colitis with an IEL count < 10 were included in this study. Increased IELs were not confined to patients with diarrhea as a primary presenting symptom, but were also present in patients with abdominal pain (n = 7), constipation (n = 3) and loss of weight (n = 1).
CONCLUSION: Immunohistochemistry using CD3 is of value in identifying and quantifying IELs for the presence of microscopic colitis in patients with diarrhea-predominant IBS.
Nooroudien Mohamed; Monique Marais; Juanita Bezuidenhout
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  World journal of gastroenterology : WJG     Volume:  17     ISSN:  2219-2840     ISO Abbreviation:  World J. Gastroenterol.     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-04-29     Completed Date:  2011-08-11     Revised Date:  2014-05-20    
Medline Journal Info:
Nlm Unique ID:  100883448     Medline TA:  World J Gastroenterol     Country:  China    
Other Details:
Languages:  eng     Pagination:  1996-2002     Citation Subset:  IM    
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MeSH Terms
Antigens, CD3 / metabolism
Colitis, Lymphocytic / complications,  diagnosis,  pathology,  physiopathology
Colitis, Microscopic / complications*,  diagnosis*,  pathology,  physiopathology
Colon / cytology,  pathology
Diarrhea / etiology*
Lymphocytes / cytology
Middle Aged
Retrospective Studies
Young Adult
Reg. No./Substance:
0/Antigens, CD3

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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