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

Am J Gastroenterol. 2001 Apr;96(4):1091-5. doi: 10.1111/j.1572-0241.2001.03745.x.


Objective: Patients referred for chronic diarrhea frequently undergo endoscopic evaluation. There are limited data on the role for colonoscopy with biopsy and ileoscopy for patients with chronic diarrhea.

Methods: We reviewed the charts of 228 patients with chronic diarrhea evaluated by colonoscopy between November 1995 and March 1998. Chronic diarrhea was defined as loose, frequent bowel movements for a minimum of 4 wk. Patients were excluded if biopsies were not performed in normal colons, if they had undergone previous bowel surgery, a history of inflammatory bowel disease, 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 histological 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 diseases (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 patients with chronic diarrhea yielding a histological diagnosis in 31% of patients without a previous diagnosis. Ileoscopy complemented colonoscopy findings in a minority of patients with chronic diarrhea and was essential for a diagnosis in only two patients.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Biopsy
  • Chronic Disease
  • Colon / pathology*
  • Colonoscopy*
  • Diarrhea / etiology*
  • Diarrhea / pathology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies