Usefulness of colonoscopy with biopsy in the evaluation of patients with chronic diarrhea

OBJECTIVE: Patients referred for chronic diarrhea frequently undergo endosc opic evaluation. There are limited data on the role for colonoscopy with bi opsy and ileoscopy for patients with chronic diarrhea. METHODS: We reviewed the charts of 228 patients with chronic diarrhea evalu ated by colonoscopy between November 1995 and March 1998. Chronic diarrhea was defined as loose, frequent bowel movements for a minimum of 4 wk. Patie nts were excluded if biopsies were not performed in normal colons, if they had undergone previous bowel surgery, a history of inflammatory bowel disea se, HIV, or an inadequate colonoscopy. RESULTS: One hundred sixty-eight patients were included in the analysis, of whom 142 (85%) had ileoscopy. Colonoscopy and biopsy yielded a specific hi stological diagnosis in 52 (31%) patients. These included Crohn's disease ( 9), ulcerative colitis (7), lymphocytic colitis (10), collagenous colitis ( 3), ischemic colitis (3), infectious colitis (6), and miscellaneous disease s (14). Ileoscopy yielded significant findings in 3% of patients (four with Crohn's disease and one with infection). CONCLUSIONS: Colonoscopy and biopsy is useful in the investigation of patie nts with chronic diarrhea yielding a histological diagnosis in 31% of patie nts without a previous diagnosis. Ileoscopy complemented colonoscopy findin gs in a minority of patients with chronic diarrhea and was essential for a diagnosis in only two patients. (Am J Gastroenterol 2001;96:1091-1095. (C) 2001 by Am. Coll. of Gastroenterology).