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[Collagenous duodenitis and ileitis in a patient with collagenous colitis].

Collagenous colitis is a disease accompanied by chronic watery diarrhea, of which the etiology is unknown. Sporadic cases of collagen deposits in the upper gastrointestinal tract are meanwhile reported. We here report the case of a 53-year-old female patient suffering from collagenous colitis with additional collagen deposits in the duodenum and ileum. The favourable effect of a therapeutical trial with bismuth nitrate is described.

Basement Membrane↗

Budesonide in the treatment of collagenous colitis.

Collagenous colitis is characterized by watery diarrhea and inflammatory infiltration associated with a subepithelial collagen deposit on colonic biopsies despite a normal or subnormal endoscopic appearance. We here describe 5 patients treated with the locally active steroid budesonide. Complete and partial response was observed in 3 and 2 patients, respectively. Budesonide thus seems to be of therapeutic benefit in collagenous colitis. Prospective randomized long-term studies are needed to support this hypothesis.

Adult↗

Collagenous colitis.

Collagenous colitis is a very rarely recognized disease characterized clinically by watery diarrhoea and histologically by a broad, band-like deposition of collagen under the surface epithelium of the colon and rectum. Two cases of collagenous colitis are reported in this paper. After treatment of one of the patients with metronidazole, the symptoms cleared up and biopsy specimens from the colon showed regression of the pathological picture. The pathogenesis of the diarrhoea is discussed. The aetiological agent seems to be infectious, but is still unknown.

Adult↗

Short- and long-term follow-up of treatment for lymphocytic and collagenous colitis.

Collagenous colitis and lymphocytic colitis cause chronic watery diarrhea. Multiple therapies have been found to improve symptoms but there have been few long-term follow-up studies. Our goal was to obtain long-term clinical follow-up on a cohort of patients with independently confirmed typical histopathologic changes. Pathology slides from 32 cases of collagenous or lymphocytic colitis patients from 1988-1992 were independently reviewed. Twenty-five cases were confirmed by both groups of pathologist as collagenous or lymphocytic colitis. For these 25 patients, charts were reviewed and telephone follow-up interviews were performed in 1992 and 1995. Seven of 32 (22%) of the original cases were not confirmed on independent pathologic interpretation. A 15.8% discordance rate was found between the different groups of pathologists. Patient demographics were similar to previously published reports except one-half of our patients had diarrhea of only 6 months or less. Eighty-one percent of patients receiving 5-ASA agents reported improvement as well as 100% of those receiving prednisone. At 23 month follow-up 86% of patients reported improvement in diarrhea and only 32% required routine medications. At 47 month follow-up all patients reported improved diarrhea and only 29% required routine medications. Collagenous and lymphocytic colitis can sometimes be identified in patients with relatively brief duration diarrhea. Clinical parameters and response to therapy are similar for collagenous or lymphocytic colitis. Most patients with lymphocytic and collagenous colitis improve with therapy such as 5-ASA preparations or steroids. Over a follow-up period of several years, most patients have improvement in diarrhea and generally do not require maintenance medications. Independent pathologic confirmation of the diagnosis should be obtained in patients not responding to therapy.

Aged↗

Collagenous colitis and lymphocytic colitis.

Collagenous and lymphocytic colitis are newly recognized causes of chronic watery diarrhea that typically affect middle-aged patients. Although endoscopic studies are normal, inflammatory changes and (in the case of collagenous colitis) collagen deposition occur histologically in the colonic mucosa. The pathogenesis of these disorders remains a mystery, but the possible causes are intriguing. Patients may experience spontaneous remissions and relapses, but treatment with sulfasalazine or prednisone is usually effective for patients with distressing symptoms.

Adolescent↗

Focal lymphocytic colitis and collagenous colitis: patterns of Crohn's colitis?

The morphologic findings in mildly active colonic Crohn's disease (CD) include crypt disarray, patchy edema, and small lymphoid aggregates with neutrophils, sometimes associated with aphthous ulcers. We describe four patients with CD whose colonic biopsies focally showed a lymphocytic colitis morphology, and one patient with CD whose biopsies showed a collagenous colitis morphology. The lymphocytic and collagenous colitis patterns of injury preceded the eventual clinical pathologic diagnosis of CD in four patients. Colonoscopic abnormalities were found in four patients. The lymphocytic colitis pattern was focal, involving some biopsy fragments, whereas other biopsy fragments were normal or had minimal nonspecific inflammation. In one patient, moderate numbers of neutrophils were admixed with the lymphoplasmacytic infiltrates. The presence of colonoscopic abnormalities, focal changes, and moderate admixed neutrophils could assist in the distinction from lymphocytic or collagenous colitis, both of which are colonoscopically normal, usually diffuse, and devoid of, or contain only a sparse number of, neutrophils. A limited number of biopsy fragments may be incorrectly interpreted as lymphocytic or collagenous colitis. The temporal relationships suggest that these morphologic patterns precede typical active CD.

Adolescent↗

Joint manifestations in gastrointestinal diseases. 2. Whipple's disease, enteric infections, intestinal bypass operations, gluten-sensitive enteropathy, pseudomembranous colitis and collagenous colitis.

This review addresses the clinical picture of rheumatic diseases seen in Whipple's disease, gluten-sensitive enteropathy, pseudomembranous colitis, collagenous colitis and that developing after enteric infections and intestinal bypass operations for morbid obesity. These disorders exemplify the interplay between antigen entrance through the gastrointestinal canal, specific bacterial properties and genetic host factors such as HLA B27. In most cases such as interplay results in formation of circulating immune complexes causing the development of peripheral joint disease.

Bacterial Infections↗

Nonspecific radiographic abnormalities in collagenous colitis.

Collagenous colitis (CC) is characterized clinically by a chronic, watery diarrhea. Pathologically, there is a chronic lymphocytic infiltrate with abnormal thickening of the subepithelial collagen layer. This disease occurs predominantly in females, and is more frequent in the elderly. Previous clinical studies suggest that radiographic examination of the colon is of no value in this condition. We reviewed five cases of CC all of whom had colon examination within 2 weeks of the biopsy. Two of our patients showed evidence of mucosal granularity and irregularity of the rectosigmoid on double-contrast barium enema (DCBE). One patient had nodularity of the rectal wall on single-contrast colon examination. Two patients had no inflammatory changes evident on colon examination. These radiographic changes are nonspecific and may be seen in other forms of colitis, particularly ulcerative colitis and nonspecific proctitis.

Adolescent↗

Collagenous colitis.

Collagenous colitis is a newly described entity that clinically manifests itself as watery diarrhea of long-standing duration. The main histopathologic characteristic is the presence of a collagen band immediately beneath the colonic surface epithelium. Ultrastructurally, the collagen is deposited beneath the basement membrane, which is intact. Pathogenetically, an aberrant function of the pericryptal fibroblastic sheath may be involved.

Cathartics↗

Microscopic colitis syndrome: lymphocytic colitis and collagenous colitis.

Microscopic colitis is a syndrome consisting of chronic watery diarrhea, a normal or near-normal gross appearance of the colonic lining, and a specific histological picture described as either lymphocytic colitis or collagenous colitis. Since its initial descriptions a quarter of a century ago, microscopic colitis has become a frequent diagnosis in patients with chronic diarrhea. Understanding of the cause and pathogenesis of microscopic colitis remain incomplete, but potentially important clues have been discovered that shed light on predisposing factors. In particular, specific HLA-DQ genotypes may be permissive for the development of microscopic colitis, and suggest a linkage to the pathogenesis of celiac sprue. Although the differential diagnosis of chronic watery diarrhea is broad, the diagnosis of microscopic colitis is straightforward, involving endoscopic inspection of the colonic mucosa and proper pathologic interpretation of biopsy specimens. As the limitations of drugs ordinarily used for other forms of inflammatory bowel disease are being recognized, new approaches, such as the use of bismuth subsalicylate, are being evaluated. The prognosis of patients with microscopic colitis syndrome remains good, and symptomatic improvement can be expected in most patients.

Adult↗

Primary AL-amyloidosis, ulcerative colitis and collagenous colitis in a 57-year-old woman: a case study.

A 57-year-old woman with AL-amyloid deposits in the heart, gastrointestinal tract and the liver developed ulcerative colitis, which was treated with glucocorticosteroids and 5-aminosalicylic acid, with good response. The AL-amyloidosis was successfully treated with high-dose chemotherapy and autologous stem-cell transplantation. The patient was in good clinical condition for 18 months after treatment, until she developed diarrhea, which was found to be due to collagenous colitis. Two years after treatment of amyloidosis, the patient is in excellent condition, the symptoms of heart failure have stabilized and no adverse effects of the treatment regime have been observed. The bowel diseases are in clinical remission.

Amyloid↗

["Microscopic colitis" and collagenous colitis. Unusual explanation of diarrhea of unknown origin].

The article describes two female patients with severe diarrhoea. Both patients were suspected of having an organic diarrhoea syndrome and underwent extensive investigations. No specific diagnoses such as inflammatory bowel disease, pancreatic cholera, malabsorption and surreptitous ingestion of laxatives could be established. Histologic examination of biopsy specimens from apparently normal colon revealed microscopic changes characteristic of "microscopic colitis" in one of the patients, and of collagenous colitis in the other. The authors discuss similarities between these two microscopic abnormalities in colonic mucosa and their close association with chronic watery diarrhoea.

Adult↗

[Microscopic colitis and collagenous colitis. An entity not yet reported in Chile].

Collagenous and microscopic colitis have been described as causes for abundant watery diarrhea with a normal radiologic and endoscopic aspect of the colonic mucosa. Microscopic colitis is characterized by diffuse intraepithelial lymphocytic infiltration and collagenous colitis by thickening of subepithelial collagen layer greater than 15 microns with or without inflammatory changes of the mucosa. Here are reported 5 patients with microscopic colitis and 4 with collagenous colitis. The mean age was 52 years (range 40 to 68) with an equal sex distribution. Diarrhea was of longstanding duration without weight loss, anemia or hypoalbuminemia. Occasionally the volume of diarrhea was over 1 L a day. One patient had steatorrhea that proved resistant to a gluten free diet. Endoscopic and radiologic findings were normal in every patient and the diagnosis was based on typical histology. Azulfidine therapy was successful in 7 patients and prednisone in another. Colonic biopsy should be performed in every patient with chronic diarrhea.

Adult↗

Microscopic colitis progressed to collagenous colitis: a morphometric study.

Microscopic (also called lymphocytic) colitis and collagenous colitis are two newly recognised clinicopathologic entities of unknown aetiology presenting with chronic watery diarrhoea. In both conditions, the colon appears normal by barium enema and colonoscopy, however, colonic biopsies reveal infiltration of plasma cells and neutrophils within the lamina propria and increased intraepithelial lymphocytes within the surface epithelium. Lack of a thickened collagen band beneath the surface epithelium histologically differentiates microscopic from collagenous colitis. The exact relationship between the two disorders is as yet unknown. The two entities may be variants of the same spectrum of disease or distinct conditions with and without collagen table thickening. The present case report shows progression of microscopic colitis to collagenous colitis in sequential colonic biopsies taken from a patient during a 7-year endoscopic follow-up suggesting that progression of microscopic to collagenous colitis is a possibility and the two diseases are likely to represent variants of the same condition.

Adult↗

[Diarrhea due to rare forms of colitis: microscopic (lymphocytic, collagenous) colitis and spirochetosis].

Lymphocytic and collagenous colitis, uncommon entities that are identifiable by histopathologic examination only, and intestinal spirochetosis may cause chronic diarrhea. Data on incidence, histopathology, and diseases associated with these infrequent forms of colitis are reviewed. Etiology and pathogenesis of lymphocytic and collagenous colitis are still unknown, but immuno-inflammatory factors may be involved in both forms as well as, in collagenous colitis, primary disorders of collagen metabolism or drug-induced toxic effects. The significance of intestinal colonization by spirochetes is disputed; however, recent results indicate that these microorganisms are capable of inducing disease.

Adult↗

Collagenous colitis and lymphocytic colitis.

The most recently recognized and least understood forms of inflammatory bowel disease are two types of idiopathic microscopic colitis-collagenous colitis and lymphocytic colitis. These disorders share many clinical and histologic features, but they have a few notable differences. Whether these are two distinct entities or different presentations of the same disease remains controversial. Bismuth subsalicylate is effective in some patients and treatment is symptomatic and empirical in others. Unlike ulcerative colitis and Crohn's disease, these forms of inflammatory bowel disease rarely require surgery. Ileostomy with or without colectomy is curative for the rare patient with severe symptoms that are refractory to medical measures. Collagenous and lymphocytic colitis are not associated with an increased risk of malignancy.

Biopsy, Needle↗