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Distribution of histopathological features along the colon in microscopic colitis

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  • Anne-Marie Kanstrup Fiehn, Innovational Counsil, Zealand University Hospital, Region Zealand
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  • Stephan Miehlke, Institute of Biophysics and Radiobiology, University-Hospital Hamburg-Eppendorf, Hamburg
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  • Daniela Aust, Department of Internal Medicine 1, University Hospital Dresden, Technische Universität Dresden (TU Dresden), 01307, Dresden, Germany.
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  • Michael Vieth, Institute for Pathology, Aalborg University Hospital
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  • Ole Bonderup
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  • Fernando Fernández-Bañares, Department of Gastroenterology, Hospital Universitari Mútua Terrassa, Terrassa, Barcelona, Spain.
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  • Emese Mihaly, Semmelweis Univ, Semmelweis University, Dept Vasc Surg
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  • Juozas Kupcinskas, Lithuanian University of Health Sciences
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  • Ahmed Madisch, Department of Gastroenterology and Department of Pediatric Gastroenterology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
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  • Lars Kristian Munck, 1Copenhagen University Hospital, Copenhagen, Denmark. 2Aarhus University Hospital, Aarhus, Denmark. 3University of Copenhagen, Copenhagen, Denmark. 4Odense University Hospital, Odense, Denmark.
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  • Tanju Nacak, Dr Falk Pharma GmbH, Freiburg, Germany.
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  • Ralf Mohrbacher, Dr Falk Pharma GmbH, Freiburg, Germany.
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  • Ralph Mueller, Dr Falk Pharma GmbH, Freiburg, Germany.
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  • Roland Greinwald, Dr Falk Pharma GmbH, Freiburg, Germany.
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  • Andreas Münch, Department of Infectious Diseases, Linköping University Hospital, Linköping, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.

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.

Original languageEnglish
JournalInternational Journal of Colorectal Disease
Pages (from-to)151-159
Number of pages9
Publication statusPublished - Jan 2021

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