Background In patients with chronic diarrhoea, a colonoscopy may identify inflammatory causes or some occult disease and can also show normal mucosa. Serial biopsies of intestinal mucosa can be useful for a differential diagnosis and to modify treatment.

Aim To evaluate whether the biopsies performed in patients with chronic diarrhoea and a normal colonoscopy contribute to the differential diagnosis and alter the therapeutic approach.

Methods Patients with chronic diarrhoea and a normal colonoscopy underwent serial biopsies of the terminal ileum, ceacum, ascending colon, transverse colon, descending colon and rectum. Patients from September 2015 till date who met the inclusion criteria were selected.

Results Total no. of patients- 300

75 showed histological changes:

40 patients had active colitis/focal active colitis.

12 lymphocytic colitis,

05 eosinophilic inflammation;

10 lymphoid hyperplasia;

05 diverticuli-associated colitis.

03 melanosis.

The sites with the largest number of changes were the terminal ileum and right colon.

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Abstract IDDF2024-ABS-0013 Figure 1

Normal colonoscopy But microscopic colitis on random mucosal biopsy.

Conclusions Serial biopsies in patients with chronic diarrhoea and normal colonoscopy identified changes in almost 25 % of cases (IDDF2024-ABS-0013 Figure 1. Normal colonoscopy But microscopic colitis on random mucosal biopsy) and modified the treatment after identification of collagenous, lymphocytic and Eosinophilic colitis.