title: Importance of biopsies and histological evaluation in patients with chronic diarrhea and normal colonoscopies.
abstract: BACKGROUND
  In patients with chronic diarrhea, colonoscopy may identify inflammatory causes or some occult disease, and also can show a normal mucosa. Serial biopsies of intestinal mucosa can be useful for a differential diagnosis, and to modify the treatment.
  
  
  OBJECTIVE
  To evaluate whether the biopsies performed in patients with chronic diarrhea and a normal colonoscopy contribute to the differential diagnosis and alter the therapeutic approach.
  
  
  METHODS
  A descriptive, retrospective and cross-sectional study using a computerized database was done. Patients with chronic diarrhea and a normal colonoscopy underwent serial biopsies of the terminal ileum, ascending colon and rectum.
  
  
  RESULTS
  From 398 records, 214 were excluded. Of the 184 patients enrolled, 91 showed histological changes: 40% nonspecific inflammation; 5.18% lymphocytic inflammation, 10.37% eosinophilic inflammation; 39.26% lymphoid hyperplasia; 2.22% collagenous colitis; 2.22% melanosis; and 0.74% pseudomelanose. The sites with the largest number of changes were the terminal ileum and right colon.
  
  
  CONCLUSIONS
  Serial biopsies in patients with chronic diarrhea and normal colonoscopy identified changes in almost 50% of cases and 22% of these cases may had modified the treatment after identification of collagenous, lymphocytic and eosinophilic colitis.
authors.affiliation: Gastroclínica Cascavel, Cascavel, PR, Brazil.
authors.forename: Franciane Mayra Nicoli
authors.initials: FM
authors.lastname: Kagueyama
authors.affiliation: Gastroclínica Cascavel, Cascavel, PR, Brazil.
authors.forename: Fernanda Michely
authors.initials: FM
authors.lastname: Nicoli
authors.affiliation: Gastroclínica Cascavel, Cascavel, PR, Brazil.
authors.forename: Mauro Willemann
authors.initials: MW
authors.lastname: Bonatto
authors.affiliation: Gastroclínica Cascavel, Cascavel, PR, Brazil.
authors.forename: Ivan Roberto Bonotto
authors.initials: IR
authors.lastname: Orso
mesh_terms: D000328:Adult; D001706:Biopsy; D002908:Chronic Disease; D003106:Colon / Q000473:pathology*; D003113:Colonoscopy; D003430:Cross-Sectional Studies; D003967:Diarrhea / Q000209:etiology*; D005260:Female; D006801:Humans; D007082:Ileum / Q000473:pathology*; D007410:Intestinal Diseases / Q000150:complications* / Q000473:pathology*; D008297:Male; D012007:Rectum / Q000473:pathology*; D012189:Retrospective Studies