Background: An inherent degree of nonpathological mild inflammation in the cecum has been described informally among pathologists. This low-grade inflammation is often reported as "nonspecific colitis," which can confuse clinicians. Our objective was to characterize and quantify inflammatory changes in the cecum and rectum of healthy adults in a blinded study.
Methods: A total of 85 adults free of gastrointestinal symptoms and history of disease underwent colonoscopy plus cecal and rectal biopsies as part of a case control study. Slides were scored independently by two observers. Histology scores 0 (none) to 3 (severe) were assigned for: epithelial injury, crypt architecture, lamina propria cellularity, subcryptal cellularity, and cryptitis. Slides were scored in a blinded fashion. Biopsy slides of cecum and rectum from fifteen patients with ulcerative colitis were randomly distributed within our sample to limit observer bias.
Results: Scores for inflammation were greater in the cecum versus rectum for: epithelial injury (0.45 vs 0.26, P= 0.03), crypt architecture distortion (0.25 vs 0.09, P= 0.03), lamina propria cellularity (1.13 vs 0.34, P < 0.001), and cryptitis (0.40 vs 0.11, P < 0.001).
Conclusions: Increased microscopic inflammation of the cecum is present in healthy individuals, compared to the rectum. Caution should be used when describing "colitis" in cecal biopsies. Clinicians should be cautious in their response to biopsy reports identifying patients as having clinically significant "colitis" that is limited to the cecum.