THE CLINICAL-SIGNIFICANCE OF FOCAL ACTIVE COLITIS

Focal crypt injury by neutrophils (cryptitis/crypt abscesses), or foca l active colitis (FAG), is a common isolated finding in endoscopic col orectal biopsies. Focal active colitis is often thought of as a featur e of Crohn's disease, but may also be seen in ischemia, infections, pa rtially treated ulcerative colitis, and as an isolated finding in pati ents undergoing endoscopy to exclude neoplasia. Clinical, endoscopic, and pathological data were retrospectively reviewed from 49 patients w ith focal active colitis, who had no other diagnostic findings on colo rectal biopsy and no history of chronic inflammatory bowel disease. Th e histological findings were correlated with clinical diagnoses. Follo w-up information was available for 42 of 49 focal active colitis patie nts. None developed inflammatory bowel disease; however, 19 patients h ad an acute self-limited colitis-like diarrheal illness, 11 had incide ntal focal active colitis (patients without diarrhea that were endosco ped to exclude colonic neoplasia and found to have asymptomatic FAG), 6 had irritable bowel syndrome, 4 had antibiotic-associated colitis, a nd 2 had ischemic colitis. Twenty patients were immunosuppressed, and 19 were taking nonsteroidal anti-inflammatory drugs. No histological f eatures predicted final diagnoses. FAC did not predict the development of chronic colitis, even when mild crypt distortion or slight basal p lasmacytosis was present. The preponderance of acute self-limited coli tis and antibiotic-associated colitis among the FAC patients, along wi th the high number of immunosuppressed patients, support the conclusio n that most FAC cases are infectious. The incidental detection of FAC in patients undergoing endoscopy to exclude colonic neoplasia was not clinically significant. The role of nonsteroidal anti-inflammatory dru gs in FAC deserves further study. Copyright (C) 1997 by W.B. Saunders Company.