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Quantitative Assessment of the Subepithelial Collagen Band Does Not Increase the Accuracy of Diagnosis of Collagenous Colitis

Carlos A. Rubio MD, PhD, Abiel Orrego MD, Anders Höög MD, PhD, Anja Porwitz MD, PhD, Fredrik Petersson MD, PhD, Göran Elmberger MD, Axel Glaessgen MD, PhD, Elina Eriksson MD, PhD, Lena Kanter MD, PhD, Georg Jaremko MD, PhD, Lars Egevad MD, PhD, Juan Laforga MD, M. Liljefors MD, Britta Löfdahl MD, Peter Norman MD, Olle Larsson MD, PhD, Robert Wanat MD, Johan Wejde MD, PhD, Peter Zickert MD, PhD, Jan Björk MD, PhD, Saverio Caini MD, Domenico Palli MD, PhD, Gabriella Nesi MD, PhD
DOI: http://dx.doi.org/10.1309/K7MH8UCK3MR7Q77L 375-381 First published online: 1 September 2008


The thickness of eosinophilic band in collagenous colitis (CC) was assessed by 3 methods: histologic estimates (22 observers), conventional measurements using a calibrated micrometric scale (1 observer), and semiautomatic micrometric measurements (1 observer). By the histologic estimate technique, 7.4% of the results failed to diagnose CC; by calibrated micrometry, the failure was 6% and by semiautomatic micrometry, 6%. The main difficulty in measuring the thickness of the CC band is that the deeper border of the band appears fuzzy and hairy-irregular. CC should be defined not exclusively on the basis of the thickness of the collagen table, but as a microscopic constellation characterized by a distorted superficial cell arrangement, with areas of epithelial denudation and inflammatory cells in the superficial epithelium and the lamina propria. In agreement with Lazenby’s statement: “Focusing solely on the collagen band can result in both over- and underdiagnosis.”

Key Words:
  • Eosinophilic band
  • Collagenous colitis
  • Micrometric measurement
  • Colonic mucosa
  • Diagnostic accuracy