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[Celiac disease and collagenous colitis. A fortuitous association].

We report the cases of two patients with coeliac disease in whom chronic diarrhoea persisted in spite of strict adherence to a gluten free-diet and regression of intestinal villous atrophy. Collagenous colitis was evidenced in both patients. Six cases of such association have already been described. Because of subepithelial deposition of collagen in the colon of collagenous colitis and in the small intestine of coeliac disease, it has been suggested that the colonic collagen band might reflect a toxic effect of gluten on colonic epithelium. However, thickening of the colonic collagen band during strict gluten free-diet, as observed in one of our cases, is not in favour of this hypothesis.

Adult↗

Increased eosinophil infiltration and degranulation in colonic tissue from patients with collagenous colitis.

OBJECTIVE: Eosinophils infiltrate the colonic mucosa of patients with collagenous colitis (CC), although the pathogenetic implications are unknown, including whether these eosinophils are activated and degranulate in situ. We examined eosinophil infiltration and degranulation in the intestines of patients with CC by immunofluorescence for eosinophil granule major basic protein (MBP). METHODS: We used both conventional histology (hematoxylin and eosin) and indirect MBP immunofluorescence histochemistry on colon biopsy specimens from patients with CC (n = 21) and from healthy controls (n = 9). Scoring of histological features was performed on hematoxylin and eosin-stained sections on a 0 to 3 scale. Eosinophil infiltration and degranulation, as quantified by extracellular MBP staining, were scored in each specimen on a 0 to 4 scale. RESULTS: The inflammatory infiltrate of the lamina propria, the thickness of the collagen band, the numbers of intraepithelial lymphocytes, and degree of epithelial cell damage were all significantly increased in patients with CC as compared to controls (p < 0.0001). Scores for both eosinophil infiltration and degranulation were also significantly higher in the CC group compared to controls (p < 0.0001). The degree of infiltrating eosinophils by hematoxylin and eosin was correlated with eosinophil infiltration and degranulation by MBP immunostaining; however, no other correlations were found between eosinophil infiltration or degranulation by immunofluorescence and any of the histological parameters measured in the CC group. CONCLUSIONS: Eosinophil infiltration and degranulation are increased in the colonic mucosa of patients with CC compared to healthy controls. Eosinophils and their cytotoxic granule proteins could be involved in the pathogenesis of CC. Further studies will be necessary to elucidate the mechanisms of eosinophil activation in CC.

Adult↗

Amyloidosis of the rectum mimicking collagenous colitis.

Gastrointestinal involvement in cases of systemic amyloidosis is very common. In the colorectal mucosa, amyloid deposition is ordinarily seen around vessels or diffusely in the lamina propria. We report two cases in men aged 69 and 29 years, whose rectal biopsies revealed prominent subepithelial amyloid deposits mimicking collagenous colitis. The amyloid deposits were composed of AA protein. A review of the literature has yielded only one previously reported case. Pathologists should be aware of this deposition pattern of amyloid to prevent misdiagnosis. Our cases underline the importance of the routine use of histochemical stains for amyloid in all cases of colorectal biopsies showing histologic changes suggestive of collagenous colitis.

Adult↗

Collagenous colitis--a rare cause of chronic watery diarrhoea. A case report.

Collagenous colitis is a clinicopathological syndrome occurring predominantly in middle-aged females presenting with chronic watery diarrhoea. Histologically the disorder is characterised by a mononuclear cell mucosal inflammatory infiltrate and subepithelial collagen thickening. The condition was first described in 1976 and since then approximately 100 cases have been reported in the literature. We present here the first reported case of this rare disorder in South Africa.

Aged↗

Functional asplenia and microscopic (collagenous) colitis.

A 54-year-old female presented with a pulmonary infection that resolved completely with antibiotic treatment. Peripheral blood films showed features characteristic of splenic hypofunction, and radiolabelling studies confirmed an absence of splenic reticulo-endothelial cell activity, which is typical of functional asplenia. The patient had a remote history of watery diarrhea but no clinical and laboratory features of malabsorption. Extensive upper and lower gastrointestinal tract biopsy studies revealed histopathological features of collagenous colitis without gastric or small intestinal inflammatory changes or epithelial lymphocytosis. Hyposplenism has been associated with different gastrointestinal disorders, particularly celiac disease. This is the first report of functional asplenia and microscopic collagenous colitis.

Ampicillin↗

Collagenous colitis: a transient condition? Report of two cases.

We have seen two patients with watery diarrhea whose work-up revealed a collagenous infiltration beneath the rectal epithelium. Within a year, symptoms disappeared in both. Repeated rectal biopsy revealed the disappearance of the collagen layer. Collagenous colitis may thus present as a transient condition.

Aged↗

[Collagenous colitis: macroscopically invisible, but with various treatment options].

Two female patients, aged 54 and 67 years, respectively, had suffered from watery diarrhoea for several weeks or months without cramps or blood in the stools. The findings upon physical examination, blood and faecal examination and endoscopy were normal, and subsequent histological examination of intestinal biopsies revealed collagenous colitis. After treatment with a high-fibre diet, sulphasalazine and either prednisone or budesonide, the symptoms subsided. Collagenous colitis is a chronic watery diarrhoea disorder with unknown aetiology and pathogenesis. It is characterised by macroscopically normal mucosa, while histopathologically an abnormal thickening of the subepithelial collagenous layer and an increase in the number of intra-epithelial lymphocytes is found. There are various treatment options such as dietary fibre, mesalazine or bismuthsubsalicylate. Recently budesonide has been found to have a favourable effect both clinically and histologically. Complications of the disease are rare.

Aged↗

Collagenous colitis: a case report and review of the literature.

A case of collagenous colitis is reported and the literature reviewed. The disease presents with watery diarrhea and abdominal pain in middle-aged subjects. Women predominate in the small number of reported cases. Colonic and rectal biopsies show excessive collagenization of the so-called collagen table in the superficial lamina propria. There is an associated degeneration and desquamation of the interglandular epithelial lining cells. The cause is not known but the clinical course with symptomatic treatment can wax and wane with corresponding deterioration or improvement in the biopsy features.

Adult↗

Collagenous colitis.

Repeated colonic and rectal biopsies from a 47-year-old woman with chronic watery diarrhoea showed an approximately 50 micrometer thick subepithelial band-like collagenous deposit. The histopathological and clinical picture was consistent with the recently described condition of 'collagenous colitis'.

Chronic Disease↗

[Collagenous colitis].

We present in this article the cases of two women afflicted with aqueous chronic diarrhea with normal analysis, radiology, and endoscopy, but presenting sigmoid biopsy of collagenous colitis. One of them was treated with omeprazol and the other with corticoids. Despite not having found anomalies in the endoscopy, we recommend the practice of rectosigmoid biopsy in all cases of chronic diarrhea.

Adrenal Cortex Hormones↗

Collagenous colitis: an ultrastructural study of a case.

A case of so-called collagenous colitis is described. This entity, featured clinically by watery diarrhea, is characterized histologically by a 50-60 micrometer fibrous layer immediately beneath the surface epithelium. Ultrastructural changes in the endothelial cells and the basement membranes of the superficial capillaries of the colonic lamina propria, as well as concentric collagenous encasement of these capillaries, are described.

Capillaries↗

[Collagenous colitis associated with rheumatoid arthritis].

A patient diagnosed as having well-tolerated rheumatoid arthritis and diarrhea is described. The female patient in question was diagnosed as suffering from collagenous colitis by means of a colon biopsy. The association of this clinical state with immunological disease is discussed.

Adult↗

Co-occurrence of psoriatic arthritis with collagenous colitis: clinicopathologic findings of a case.

A 58-year-old man developed psoriatic arthritis and, after 6 months, persistent watery diarrhoea. Biopsies from the colorectal mucosa showed thickened subepithelial collagen consistent with collagenous colitis. There also was an inflammatory cell infiltration (mainly lymphocytes and monocytes) in the chorion. These findings and the parallel course of articular and bowel complaints suggest a clinicopathologic correlation between arthritis and colic involvement.

Anti-Inflammatory Agents, Non-Steroidal↗