title: Specific histological abnormalities are more likely in biopsies of endoscopically normal large bowel after the age of 60 years.
abstract: OBJECTIVE
  Colonic and rectal biopsies, often taken from an endoscopically normal large bowel, form a significant proportion of the histopathology workload. The aim of this study was to determine diagnostic yield from mucosal biopsies in patients with normal colonoscopy or sigmoidoscopy, and whether or not diarrhoea is predictive of abnormal histology.
  
  
  RESULTS
  A retrospective analysis of pathology requests, endoscopy and pathology reports taken during 1 year was undertaken in a tertiary care hospital for all biopsies from endoscopically normal ileal, colonic and rectal mucosa. Of 626 patients fulfilling inclusion criteria, 602 had at least one colonic or rectal biopsy. Colorectal histology was abnormal in 65 (14.5%) of 447 patients with diarrhoea, while of 155 patients without diarrhoea, histology was abnormal in 17 (11%; P=0.41). Patients older than 60 years had a markedly increased likelihood of a specific histological abnormality [odds ratio 2.76 (1.30-5.79); P=0.0045]. Diagnoses included microscopic colitis, distorted mucosal architecture consistent with inflammatory bowel disease, ischaemia, polyps, mucosal prolapse and schistosomiasis.
  
  
  CONCLUSIONS
  Biopsy of an endoscopically normal large bowel, and of the normal terminal ileum in isolation, yields little abnormal histology. Diarrhoea per se does not identify patients at higher risk of abnormal histology. Increased age, however, does, and mucosal biopsy in the endoscopically normal colon and rectum may be more cost-effective in patients aged more than 60 years.
authors.affiliation: Department of Pathology, Southern General Hospital, Glasgow, UK.
authors.forename: Orla H
authors.initials: OH
authors.lastname: O'Mahony
authors.forename: Margaret
authors.initials: M
authors.lastname: Burgoyne
authors.forename: James J
authors.initials: JJ
authors.lastname: Going
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000191:economics; D003092:Colitis / Q000150:complications / Q000175:diagnosis / Q000473:pathology*; D003106:Colon / Q000473:pathology*; D003111:Colonic Polyps / Q000150:complications / Q000175:diagnosis / Q000473:pathology*; D003113:Colonoscopy / Q000191:economics; D003362:Cost-Benefit Analysis; D003967:Diarrhea / Q000209:etiology; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications / Q000175:diagnosis / Q000473:pathology*; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012007:Rectum / Q000473:pathology*; D012189:Retrospective Studies; D012812:Sigmoidoscopy / Q000191:economics; D055815:Young Adult