Is It Really Colitis?

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Abstract
Histologically normal or near-normal colonic biopsies from patients with diarrhea make up a significant proportion of routine gastrointestinal biopsy cases. Recognizing and reporting these biopsies as normal is important, because it facilitates diagnosis and management of patients presumed to have irritable bowel syndrome. There are a number of trivial and/or iatrogenic deviations from normal found in colorectal biopsies. These must be separated from true disease or inaccurate, meaningless, or even harmful biopsy reports could be issued. The differential diagnosis for patients with chronic diarrhea includes the microscopic colitides. Although the typical features of lymphocytic and collagenous colitis are familiar to most pathologists, some cases of microscopic colitis have atypical features that could obscure the correct diagnosis.