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PubMed1992

Subepithelial collagen table thickness in colon specimens from patients with microscopic colitis and collagenous colitis.

Microscopic colitis and collagenous colitis are similar conditions that are differentiated by the presence or absence of subepithelial collagen table thickening. To better understand the relationship between these two disorders and the role of collagen table thickening in the pathogenesis of diarrhea, colonic mucosal biopsy specimens from 24 patients with microscopic or collagenous colitis and 9 control subjects were analyzed using a computer-assisted morphometric method to evaluate the average thickness of the subepithelial collagen table. The collagen table thickness in colitis patients taken together formed a multimodal rather than a unimodal distribution. There was no tendency for collagen table thickening to increase with age or with duration of symptoms. In general, the types and distribution of inflammatory cells were similar in patients with normal and thickened collagen tables. Stool weight correlated with lamina propria cellularity but not with collagen table thickening. The multimodal distribution of collagen table thickening and the lack of correlation with age, duration of symptoms, or inflammation suggest that microscopic colitis and collagenous colitis are discrete conditions, although the inflammatory changes in the two conditions are similar. Moreover, because stool weight correlates with lamina propria cellularity but not with collagen table thickening, diarrhea probably is caused by the inflammatory changes and not by collagen table thickening per se.

Adult↗
PubMed2003

Microscopic colitis: an underdiagnosed cause of chronic diarrhoea--the clue is in the biopsies.

Microscopic forms of colitis (collagenous colitis and lymphocytic colitis) are uncommon but important causes of chronic diarrhoea that are often overlooked. The clinical features of these disorders are similar, and they are more common in middle-aged females, although the female predominance is greater in collagenous colitis. Although their cause is unclear, both are associated with a variety of autoimmune diseases. Colonoscopy and barium enema are typically normal, so that the diagnosis depends on the demonstration of characteristic changes on histopathological examination of colorectal biopsies. These should be taken in all patients undergoing colonoscopy for the investigation of chronic diarrhoea. There are no large controlled trials of therapy available. Treatment is empirical, generally using the same agents as for inflammatory bowel -disease. Assessment of therapy is also difficult as spontaneous remissions occur often.

Adult↗
PubMed1994

Collagenous and microscopic colitis: clinical importance.

Minimal-change colitis and microscopic colitis are clinicopathological terms for diarrhoea with normal endoscopic or barium enema findings. Some controversy about the exact definitions and terminology still exists. Some forms of minimal-change colitis may overlap with "self-limited" colitis (infectious colitis) or may be due to (surreptitious) use of laxatives or other drugs. In recent years it has become clear however that some genuine forms of chronic colitis can be diagnosed only by microscopic examination of multiple colonic biopsies while macroscopy is negative and hence can be called "microscopic colitis". Collagenous colitis and lymphocytic colitis are at present two forms of this type of colitis which are more or less well defined both clinically and pathologically. Chronic watery diarrhoea is the main symptom for both. The symptoms of collagenous colitis appear most commonly in the sixth decade. Women are affected about 4 times more frequently than men. The major microscopic characteristic is a thickened collagen layer underneath the intercryptal surface epithelium. The major characteristic of lymphocytic colitis is an increase in number of interepithelial lymphocytes. Both conditions are characterized by signs of mucosal inflammation. Clinically, collagenous colitis is characterized by long-lasting diarrhoea. In patients with lymphocytic colitis the period of chronic diarrhoea is usually shorter and female predominance is less apparent. Although the natural history of these forms of colitis is not precisely known, it appears from the data thus far published that the long-term consequences are unlikely to be dire. The true incidence, aetiology and pathogenesis are unknown for both conditions and treatment is unclear.(ABSTRACT TRUNCATED AT 250 WORDS)

Biopsy↗
PubMed1996

Collagenous gastritis associated with lymphocytic colitis.

Collagenous sprue and collagenous colitis are two well-recognized idiopathic enteritides whose defining histologic attribute is fibrous thickening of the subepithelial basement membrane. Analogous changes in gastric mucosa seem to be quite rare. The term "collagenous gastritis" was recently applied for the first time to an isolated case of refractory gastritis in which distinctive subepithelial gastric fibrosis was noted. We report an additional case of this entity in a 35-year-old woman with refractory dyspepsia. In contrast to the earlier case of collagenous gastritis, our patient also had lymphocytic colitis, a type of colitis associated with watery diarrhea. Collagenous gastritis appears to be a distinct clinicopathologic entity, the histologic changes of which should be sought in patients with unexplained dyspepsia. Increased awareness of this condition and its possible clinical correlates may provide clues to its etiology and pathogenesis.

Adult↗
PubMed1985

Forms of colitis--a review of recent developments.

Recent advances in the accessibility of the bowel and in techniques for the study of colonic pathology have resulted in descriptions of several forms of colitis which were previously unrecognized and in elucidation of the etiology of previously described but poorly understood entities. Present knowledge of antibiotic-associated colitis, colitis indeterminate, acute self-limited colitis, collagenous colitis and the colitis of food allergy is reviewed.

Adult↗
PubMed2001

Familial microscopic colitis.

Collagenous and lymphocytic colitis are two inflammatory conditions of the colon that are often collectively referred to as microscopic colitis. The present report describes what is believed to be the third published case of familial microscopic colitis. A 55-year-old woman who suffered from chronic diarrhea was diagnosed with lymphocytic colitis on colonic biopsy. Subsequently, her 36-year-old daughter was diagnosed with collagenous colitis. The familial occurrence of these diseases may support an immunological hypothesis for their etiology. In addition, it supports the assumption that collagenous and lymphocytic colitis are two manifestations of the same disease process rather than two completely separate entities. The familial tendency of this disease may make a case for early colonoscopy and biopsy in relatives of patients diagnosed with microscopic colitis if they present with suggestive symptoms.

Abdominal Pain↗
PubMed2004

Microscopic colitis: a common diarrhoeal disease. An epidemiological study in Orebro, Sweden, 1993-1998.

BACKGROUND: Microscopic colitis, including collagenous colitis and lymphocytic colitis, mainly affects middle aged and older subjects, with a female predominance in collagenous colitis. The diseases have previously been regarded as rare. We present an epidemiological study of microscopic colitis in a well defined Swedish population. METHODS: Patients were retrospectively searched for in colonoscopy reports of those who had a colonoscopy in the period 1993-1998 for non-bloody diarrhoea. All colonic mucosal biopsies were reassessed using strict diagnostic criteria. RESULTS: Biopsies from 1018 patients were reassessed. Fifty one (45 female) collagenous colitis patients and 46 (31 female) lymphocytic colitis patients were diagnosed. Median age at diagnosis was 64 years in collagenous colitis and 59 years in lymphocytic colitis. The mean annual incidence of collagenous colitis was 4.9/10(5) inhabitants (95% confidence interval (CI) 3.6-6.2/10(5)) and of lymphocytic colitis 4.4/10(5) inhabitants (95% CI 3.1-5.7/10(5)). The annual incidence of collagenous colitis increased from 3.7/10(5) in 1993-1995 to 6.1/10(5) in 1996-1998 (difference 2.4/10(5) (95% CI -0.3-5.1/10(5))) whereas the incidence of lymphocytic colitis increased from 3.1/10(5) to 5.7/10(5) (difference 2.6/10(5) (95% CI 0.1-5.2/10(5))). CONCLUSIONS: The annual incidences of collagenous colitis and lymphocytic colitis are higher than considered previously and are now equal to the incidence of Crohn's disease in Sweden, and combined rates approach the incidence of ulcerative colitis. Microscopic colitis was diagnosed in 10% of all patients with non-bloody diarrhoea referred for colonoscopy and in almost 20% of those older than 70 years.

Adolescent↗
PubMed2005

Microscopic colitis: a report of two cases.

Microscopic colitis is characterized by chronic, watery, secretory diarrhea, with a normal or near-normal gross appearance of the colonic mucosa. Biopsy is diagnostic and usually reveals either lymphocytic colitis or collagenous colitis. The symptoms of collagenous colitis appear most commonly in the sixth decade. With collagenous colitis, the major microscopic characteristic is a thickened collagen layer beneath the colonic mucosa, and with lymphocytic colitis, an increase number of intraepithelial lymphocytes. Clinically, collagenous colitis is characterized by long-standing diarrhea. In patients with lymphocytic colitis, the duration of diarrhea is usually shorter and female predominance is less apparent. We report two cases of lymphocytic colitis in elderly women. Both presented with watery diarrhea of two month duration and weight loss. Extensive investigations were done and several medications failed to stop their diarrhea. Biopsy revealed lymphocytic colitis. Their diarrhea responded well to cholestyramine.

Aged↗