Human pathology · 2026
Focal active colitis: Diagnostic relevance and long-term clinical outcomes.
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Soubra Aya B, Nasser Selim M
Аннотация
BACKGROUND: Focal active colitis (FAC) is a histopathologic finding characterized by focal neutrophilic crypt injury without chronic architectural changes. Its clinical implications, particularly its association with inflammatory bowel disease (IBD), remain debated.
METHODS: We retrospectively reviewed colorectal biopsies diagnosed as FAC (2005-2024) at a tertiary center in Lebanon. Adult patients (>18 years) with isolated FAC and available clinical follow-up were included. Clinical outcomes, endoscopy, and subsequent diagnoses were analyzed.
RESULTS: 419 patients had complete follow-up data. Mean age was 52.5 years; 51.5% were female. Abdominal pain was the most common presentation (57.5%). Colonoscopy was normal in 73%. During a mean 26-month follow-up, 9 patients (2.15%) developed IBD (4 Crohn's disease, 3 ulcerative colitis, 2 unclassified). IBS was diagnosed in 33.2%, infectious colitis in 11.2%, drug-induced colitis in 8.6%, diverticular disease in 4.5%, and ischemic colitis in 0.7%. 25.3% had no identifiable etiology with negative follow-up. FAC was incidental in 10.5% and persistent in 3.8%. No histologic features predicted progression to IBD.
CONCLUSION: In this 19-year, 419-patient study, FAC was most often linked to IBS, infection, or drug-induced injury, with only 2.15% progressing to IBD. No predictive histologic features were identified. FAC remains a nonspecific finding; careful follow-up is warranted in symptomatic patients, while incidental cases are usually clinically insignificant.
METHODS: We retrospectively reviewed colorectal biopsies diagnosed as FAC (2005-2024) at a tertiary center in Lebanon. Adult patients (>18 years) with isolated FAC and available clinical follow-up were included. Clinical outcomes, endoscopy, and subsequent diagnoses were analyzed.
RESULTS: 419 patients had complete follow-up data. Mean age was 52.5 years; 51.5% were female. Abdominal pain was the most common presentation (57.5%). Colonoscopy was normal in 73%. During a mean 26-month follow-up, 9 patients (2.15%) developed IBD (4 Crohn's disease, 3 ulcerative colitis, 2 unclassified). IBS was diagnosed in 33.2%, infectious colitis in 11.2%, drug-induced colitis in 8.6%, diverticular disease in 4.5%, and ischemic colitis in 0.7%. 25.3% had no identifiable etiology with negative follow-up. FAC was incidental in 10.5% and persistent in 3.8%. No histologic features predicted progression to IBD.
CONCLUSION: In this 19-year, 419-patient study, FAC was most often linked to IBS, infection, or drug-induced injury, with only 2.15% progressing to IBD. No predictive histologic features were identified. FAC remains a nonspecific finding; careful follow-up is warranted in symptomatic patients, while incidental cases are usually clinically insignificant.