Chronic, unexplained diarrhea: are biopsies necessary if colonoscopy is normal?

Abstract

We conclude that the yield of biopsies in diarrhea patients with macroscopically normal colons at endoscopy is low. It may be reasonable to obtain biopsies in patients with relatively severe or debilitating symptoms, with diarrhea that sounds "organic" (e.g., nocturnal stools, frequent watery stools, weight loss, elevated sedimentation rate), or in patients who are immunosuppressed. When biopsies are taken at colonoscopy, we suggest taking about six from throughout the colon and placing them into just one specimen container to help minimize costs.