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PubMedDate not supplied

[Microscopic colitis].

BACKGROUND: Microscopic colitis is responsible for a proportion of difficult diagnosis cases with chronic diarrhea. Diagnosis is clinically suspected when chemical and macroscopic examination result negative and is made only by histopathologic findings. OBJECTIVE: To describe clinical, biochemical, colonoscopic, and histologic features and the treatment response of four cases with microscopic colitis. METHODS: We inform on the findings in four females patients presenting with chronic watery diarrhea with normal biochemical and colonoscopic tests. RESULTS: In these cases, diagnoses mode were lymphocytic colitis two and collagenous colitis two. The long term duration of watery diarrhea was 5 months. The average number of depositions were 10 in 24 h. Diagnosis was made after microscopic examination of the colonic mucosa in the absence of endoscopic abnormalities and normal chemistries. All patients had a satisfactory response to treatment. CONCLUSIONS: The diagnosis of microscopic colitis is made by histopathology findings. The therapeutic response is generally satisfactory.

Adult↗
PubMed2006

Histologic study of colonic mucosa in patients with chronic diarrhea and normal colonoscopic findings.

BACKGROUND: There are controversies about the importance of biopsies of normal colon mucosa in the investigation of patients with chronic diarrhea. STUDY: Colonic and terminal ileum biopsies of 167 patients were reviewed. In 5 patients, used as controls, colonoscopy was done due to family history of colon cancer. RESULTS: The 5 patients without symptoms had no histologic abnormalities. The histologic findings in 162 patients with chronic diarrhea were as follows: 110 patients (67.9%) with normal histology, microscopic colitis not otherwise specified, and isolated small granulomas; 17 (10.5%) patients had findings of borderline diagnostic significance, including possible collagenous colitis, some features of lymphocytic colitis and melanosis coli; and 35 (21.6%) patients, with diagnostic significant histologic findings as collagenous colitis, lymphocytic colitis, minimal change microscopic colitis, eosinophilic colitis, pericrypt eosinophilic enterocolitis, intestinal spirochetosis, schistosomiasis, and Crohn's disease. Of the 52 patients with either borderline or significant diagnostic abnormalities, in 8 (15.4%) the diagnosis was done only with a proximal study (ascending, transverse, or descending colons). CONCLUSIONS: Histologic lesions of possible diagnostic value could exist in 32.1% of chronic diarrhea patients with normal colonoscopy, which can justify, in certain cases, mucosa biopsies, which might contribute for a more precise etiologic diagnosis; also, the distribution of these histologic changes has pointed out the importance of having all colon segments biopsied.

Adolescent↗
PubMed2002

Collagenous and lymphocytic colitis in Iceland.

The aim of this study was to determine the nationwide incidence of collagenous and lymphocytic colitis in Iceland and the location of histopathological changes in the large bowel. All pathology reports of patients diagnosed with or suspected of having collagenous colitis or lymphocytic colitis in the period 1995-1999 were identified. All pathology samples were reevaluated using strict diagnostic criteria. After reevaluation 125 patients fulfilled our diagnostic criteria, 71 as collagenous colitis and 54 as lymphocytic colitis. The mean annual incidence for collagenous colitis was 5.2/100,000 inhabitants, and the mean age at diagnosis was 66.1 years. The mean annual incidence for lymphocytic colitis was 4.0/100,000 inhabitants, the mean age at diagnosis was 68.7 years. Both diseases more commonly involved the colon than the rectum. The incidence of collagenous colitis and lymphocytic colitis is high in Iceland. The mean annual incidence of collagenous colitis is much higher in Iceland than hitherto reported elsewhere.

Adult↗
PubMed2006

Reduced CD1d expression in colonic epithelium in microscopic colitis.

CD1d is a member of a major histocompatibility complex class I-like molecule family. Its function may involve presenting microbial nonpeptide or lipidic antigens to T lymphocytes, therefore to serve as an important factor in normal mucosal immunity of the gastrointestinal tract. In this study, the expression level of CD1d in microscopic colitis (ie, collagenous and lymphocytic colitis) was examined, and compared with that in normal colonic mucosa. Formalin-fixed, paraffin-embedded colon biopsies with diagnosis of lymphocytic colitis (19 cases), collagenous colitis (6 cases), and no pathologic change (20 cases) were studied immunohistochemically using monoclonal antibodies against human CD1d, CD3, CD4, and CD8. CD1d staining in the epithelium and lamina propria was graded along a scale of 0 to 4. Intraepithelial CD3-positive lymphocytes were counted in an area of 300 epithelial cells for each specimen. The results show that CD1d was expressed in normal colonic epithelial cells, primarily on the basolateral membranes with a concentrated intracellular pool in the subnuclear region. The expression level was markedly reduced in both lymphocytic colitis (P<0.001) and collagenous colitis (P<0.001), along with a significant increase in the number of intraepithelial CD3/CD8 lymphocytes (P<0.001). These findings suggest that microscopic colitis is associated with decreased epithelial expression of CD1d, an important immunoregulatory molecule in the gastrointestinal tract.

Adult↗
PubMed1984

Significance of basement membrane thickening in the human colon.

Collagenous colitis is a rare condition characterised by watery diarrhoea. It is thought to be caused by a thick collagenous membrane found immediately beneath the colonic surface epithelium. We have studied specimens from 457 patients with a wide variety of large bowel diseases in order to determine the frequency, nature, and clinical correlations of the thick membranes. The normal membrane measured up to 3 microns. In 19 (4%) of the patients studied there was significant thickening (greater than 10 mu). In 12 patients the thickening ranged from 10-15 mu, and six of this group had diarrhoea. In seven, the membrane exceeded 15 mu, and six patients had diarrhoea. There was no correlation between the nature of the disease process, bleeding, pain, constipation or previous medication. It did not vary with the age, nor at different sites of the colon. We concluded that no case in this series represented an example of true collagenous colitis but that significant thickening of the membrane occurs in other disease conditions and that a thick membrane, no matter how it arises, is causally associated with profuse watery diarrhoea.

Adolescent↗
PubMed2000

Atypical forms of inflammatory bowel disease: microscopic colitis and pouchitis.

Three atypical colitides (and enterides) are collagenous colitis, lymphocytic colitis, and ileal pouchitis. Collagenous and lymphocytic colitis are similar inflammatory bowel disorders of unknown cause with symptoms including chronic watery diarrhea, occurring in middle age. Pouchitis is the most significant long-term complication in patients with ileoanal pouch anastomosis. The clinical and histologic features and management of these entities are discussed.

Journal Article↗
PubMed2006

Drug consumption and the risk of microscopic colitis.

BACKGROUND: Microscopic colitis is a rare disease of unknown etiology. It has been described that some drugs could cause or worsen the disease; however, the scientific evidence is limited. AIM: To investigate the possible association of chronic drug consumption with microscopic colitis. METHODS: This was a case-control study in which groups of cases were: Group 1-39 patients with collagenous colitis; Group 2-39 patients with lymphocytic colitis; and Group 3-52 patients with chronic watery diarrhea of functional characteristics. 103 subjects formed the control group. At diagnosis, a drug consumption history of at least 2-wk duration was registered. An age- and sex-adjusted logistic regression analysis was used, and the odds ratio (OR, 95% CI) was calculated. RESULTS: Drug consumption was more frequent in lymphocytic colitis than in the control group (92.3%vs 76.3%, P < 0.05). The mean daily number of drugs by person was also higher in lymphocytic colitis (3.79 +/- 0.44 vs 2.13 +/- 0.22, P= 0.04). The following associations as compared with the control group were observed: Group 1-Consumption of NSAIDs (46.2%vs 23%, OR 2.9, 1.3-6.4), selective serotonin reuptake inhibitors (SSRIs) (18%vs 1%, OR 21, 2.5-177), specifically, sertraline (15.4%vs 0%, P < 0.0005); Group 2-SSRIs (28%vs 1%, OR 37.7, 4.7-304), beta-blockers (13 vs 3%, OR 4.79, 1.04-20), statins (13%vs 3%, OR 4.6, 1.04-20), biphosphonates (8%vs 0%, P= 0.022); Group 3-SSRIs (15%vs 1%, OR 16.2, 2-135), statins (11.5%vs 3%, OR 5.4, 1.2-24). As compared with the chronic diarrhea group, a significant association with the usage of sertraline in LC (P= 0.005) and a trend for NSAIDs in CC (P= 0.057) were found. CONCLUSIONS: Drug consumption increases the risk of microscopic colitis. Some drugs might be trigger factors of colonic inflammation in predisposed hosts, and others might only worsen self-evolving microscopic colitis.

Aged↗
PubMed2006

[Microscopic colitis. A 20 cases series].

Microscopic colitis are defined as a chronic inflammation of a normal macroscopic colonic mucosa. We report 20 cases of microscopic colitis. Chronic diarrhea revealed the diagnosis in 95% of cases. Endoscopic examination was normal in 95% of patients. We diagnosed collagenous colitis in 65% of cases and lymphocytic colitis in 35% of cases. The treatment was based on sulphasalazine in 16 patients, on 5 aminosalicylic acid in 1 case, on gluten free diet in 2 cases and a symptomatic treatment was prescribed to one patient. A clinical remission was observed in 41.2% of patients taking sulphasalazine.

Adult↗
PubMed1997

The role of mucosal biopsy in the diagnosis of chronic diarrhea: value of multiple biopsies when colonoscopic finding is normal or nonspecific.

OBJECTIVES: There are controversies about taking routine mucosal biopsy when the gross colonoscopic finding is normal. This study was conducted to determine the frequency of clinically important histological abnormalities, prospectively, in chronic diarrhea patients with grossly normal or nonspecific colonoscopic findings. METHODS: One hundred and eighteen patients suffering from nonbloody diarrhea with average frequency of more than two times a day for more than 4 weeks were included. Multiple biopsies (cecum, ascending colon, mid-transverse colon, descending colon, sigmoid colon and rectum) were taken during colonoscopic examinations and each biopsy specimen was reviewed by one pathologist after H&E and Masson-trichrome staining. RESULTS: Clinically significant abnormalities (2 collagenous colitis, 1 lymphocytic colitis, 1 eosinophilic enterocolitis, 1 ulcerative colitis and 4 melanosis coli) were observed in 9 patients (7.6%). Sixteen cases (13.6%) of borderline histological abnormalities were observed (8 cases of possible collagenous colitis and 8 cases showing some features of lymphocytic colitis). Ninety two cases (78.8%) showed nonspecific inflammation only. CONCLUSION: Clinically important histological lesions can exist in significant percentage in spite of normal or nonspecific colonoscopic findings, which can justify routine mucosal biopsy in the evaluation of chronic diarrhea patients. The clinical significance of borderline histological abnormalities needs to be determined by careful follow-up studies.

Adolescent↗
PubMed2003

Collagenous and lymphocytic colitis. evaluation of clinical and histological features, response to treatment, and long-term follow-up.

OBJECTIVE: Data on collagenous colitis (CC) and lymphocytic colitis (LC) have been based on retrospective studies of registries of patients from multiple hospitals. Such studies may induce a selection of patients with severe forms of the disease, and conclusions about the clinical spectrum of the disease and treatment efficacy are difficult to be drawn. The aim of this study was to compare the clinical features, response to treatment, and long-term follow-up of CC and LC in a large group of patients prospectively diagnosed in a single center. METHODS: A specific program was undertaken to prospectively diagnose all patients with microscopic colitis from those referred for a full colonoscopy because of recurrent or chronic diarrhea. Detailed clinical and histological features, response to treatment, and long-term follow-up were compared in patients with confirmed CC and LC. RESULTS: Thirty-seven patients with CC and 44 with LC were included. Patients with CC were significantly younger and had a significantly longer duration of diarrhea before diagnosis than those with LC. Otherwise, clinical presentation was similar. Drug-induced disease was suspected for ticlopidine, flutamide, gold salts, and bentazepam in LC. Complete resolution of diarrhea was achieved in all patients, spontaneously occurring in nearly 20% of them. Response to salicylates (mainly, mesalazine) was significantly better in LC than in CC (86% vs 42%, p = 0.005). Cholestyramine was highly effective in patients of both groups with concomitant bile acid malabsorption. Patients with CC required prednisone more often than those with LC (30% vs 4.5%, p = 0.005). Both prednisone and budesonide controlled ileal release were highly effective in patients with CC (82% and 89% efficacy). After cessation of diarrhea, 25% of patients with LC and 30% of those with CC relapsed after a mean follow-up of around 3 yr. CONCLUSIONS: CC and LC share a similar clinical picture and have a benign course with long-term cessation of diarrhea in more than 70% of patients. Mesalazine and budesonide seem to be good options as first-line treatment in LC and CC, respectively. Cholestyramine may be a good alternative in patients with concomitant bile acid malabsorption.

Aged↗
PubMed1989

Collagenous gastritis.

Subepithelial fibrosis has previously been reported in the small intestine (collagenous sprue) and colon (collagenous colitis). We report a 15-yr-old girl with chronic gastritis and subepithelial fibrosis of the gastric corpus who presented with recurrent abdominal pain and acute upper gastrointestinal bleeding. Nodularity and erythema of the gastric corpus were persistent endoscopic findings. Biopsies revealed patchy chronic active gastritis with a striking focal thick band of collagen immediately beneath the surface epithelial cells that did not extend to deeper portions of the lamina propria. Contrast radiography demonstrated an abnormal mucosa of the gastric corpus with a mosaiclike surface pattern. Numerous studies have failed to elucidate the etiology. Despite treatment with ranitidine, sucralfate, and furazolidone, there has been no clinical or pathologic improvement. The pathogenesis and prognosis of collagenous gastritis, and its relationship to collagenous sprue and collagenous colitis, remain to be defined.

Adolescent↗
PubMed1995

The new colitides, Collagenous, lymphocytic, and diversion colitis.

Three recently described colitides are collagenous, lymphocytic, and diversion colitis. Collagenous and lymphocytic colitis are similar inflammatory bowel disorders of unknown cause that present as chronic watery diarrhea in middle age. Diversion colitis occurs as the result of surgery in which segments of the large intestine are excluded from the fecal stream. The clinical and histologic features of these entities are discussed.

Abdominal Pain↗
PubMed2004

Subepithelial basement membrane thickness in patients with normal colonic mucosal appearance in colonoscopy: results from southern Turkey.

AIM: Our aims were to determine the normal limits of subepithelial basement membrane (SEBM) thickness in order to more accurately diagnose collagenous colitis in the population from southern Turkey and to investigate into links between SEBM thickness and age, and sex. METHODS: The study included 100 patients (mean age 50.0+/-13.3 years; male, 34; female, 66) with miscellaneous gastrointestinal symptoms, and normal colonic mucosal appearance in colonoscopic evaluation. Biopsies were taken from five different regions of the colon. SEBM was measured with a calibrated eyepiece on specimens prepared with specific stains for collagen. Intensity of inflammatory cells was graded semiquantitatively. Differences in SEBM thickness among the different colon regions, and relationships between SEBM thickness and age, sex, and density of inflammatory cells were statistically evaluated. RESULTS: The cecum and rectum showed the largest amounts of infiltrate. None of the specimens showed histologic findings of collagenous colitis. The SEBM thicknesses measured for each case ranged from 3-20 microm. The biggest thickness was observed in rectal mucosa (median value: 10 microm). Cecum and ascending colon showed similar SEBM thickness (median value: 5 microm). SEBM thickness was not correlated with patient age or sex, but was positively correlated with the intensity of inflammatory cells in each colon segment. CONCLUSION: In this patient group from southern Turkey, SEBM was thickest in the rectum. Our results indicate that, in this population, SEBM thickness is not correlated with age or sex, but is positively correlated with severity of inflammation. The findings also support the concept that measuring SEBM thickness at one segment in the colon is inadequate and may be misleading.

Adult↗
PubMed2003

Luminal nitric oxide and epithelial expression of inducible and endothelial nitric oxide synthase in collagenous and lymphocytic colitis.

BACKGROUND: Colonic nitric oxide (NO) production in collagenous colitis (CC) has been studied in a small number of patients and found increased. The cellular source of NO is believed to be the colonic epithelial cells. The aim of this study was to investigate colonic NO levels in patients with CC and lymphocytic colitis (LC), to compare with the histopathological status and with the clinical activity, and to assess the epithelial expression of inducible and endothelial nitric oxide synthase (iNOS and eNOS). METHODS: We included 19 patients with CC, 8 patients with LC and 15 controls. During colonoscopy, luminal gas was sampled and NO levels were measured using the chemiluminescence technique. Mucosal biopsies were obtained for routine histopathologic examination and immunohistochemical studies of iNOS and eNOS. Clinical activity, as measured by the mean frequency of daily bowel movements during the week prior to colonoscopy, was assessed. RESULTS: Luminal NO levels, median (25-75 percentiles), in the patients with CC and LC were greatly increased compared to the controls, 1673 (145-8143) parts per billion (ppb) and 1838 (1065-2694) ppb versus 28 (20-46) ppb (P < 0.005, both). A positive association was seen between NO levels and histopathological status as well as clinical activity. Strong expression of iNOS was seen in the surface epithelium in 5 of 6 patients with CC and in 2 of 5 patients with LC. CONCLUSIONS: The fact that luminal NO levels are related to histopathological status and correlate with clinical activity indicates that NO is involved in the pathophysiology of CC and LC. The epithelial cells are the most likely source of luminal NO.

Adolescent↗
PubMedDate not supplied

Macrophage-associated chronic diarrhea of unknown origin. Preliminary observations.

The distribution of macrophages in the colonic mucosa was investigated in 13 patients with chronic diarrhea. Group I consisted of 5 patients; both colonoscopy and colonic biopsies were reported as normal. Group II included 5 patients with normal colonoscopy, but with collagenous colitis or lymphocytic colitis at histology. Group III consisted of 3 patients with mucosal inflammation at both colonoscopy and histology. Immunostain with CD68 (a macrophage marker) revealed, in all patients from Group I, a linear accumulation of CD68+ macrophages at the top of the lamina propria. In contrast, sections from patients in Groups II and III showed a random distribution of CD68+ macrophages. Since all three groups of patients here investigated had chronic diarrhea, it goes without saying that the linear recruitment of macrophages in Group I may not be the direct cause of chronic diarrhea, as no similar linear recruitment of macrophages was demonstrated in patients with collagenous colitis or with chronic inflammation. Although the cause(s) of chronic diarrhea in patients of Group I remain to be elucidated, it would appear that the recruitment of macrophages along the superficial aspect of the lamina propria mucosa (lpm) is a characteristic cellular response in patients with this subtype of chronic diarrhea.

Adult↗