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PubMed2003

A method for the detection of eosinophilic granulocytes in colonoscopic biopsies from IBD patients.

Eosinophilic granulocytes were found to be autofluorescent when Giemsa-stained sections were stimulated with indirect light fluorescence (ILF). The frequency of autofluorescent eosinophils was assessed in areas with diffuse and focal inflammation in 76 consecutive colonoscopic biopsies from patients with inflammatory bowel disease (IBD), Crohn's disease (CD = 32), ulcerative colitis (UC = 30), and collagenous colitis (CC = 7). All IBD cases had moderate to severe pancolitis. In areas with diffuse inflammation, severe eosinophilia was recorded in 39.6% or in 38 of 96 high power fields investigated in patients affected by CD, and in 3.3% or in 3 of 90 high power fields examined in patients with UC. In areas with focal inflammation, the mean percentage of eosinophils in CD was 57% (range 44-70%), and 9% in UC (range 6-26%). No focal inflammation was present in CC. In the submucosa of some CD patients, a large number of autofluorescent eosinophils and many autofluorescent cell-free granules were seen. It was inferred that these autofluorescent granules had been released from eosinophils, and that the eosinophilic granulocytes from which these granules had originated were no longer discernible. Focal eosinophilic mucosal infiltration in CD is more common than epithelioid cell granulomas, and emerges as an important parameter in the histologic differential diagnosis between colonic CD and UC.

Adolescent↗
PubMed2004

Lymphocytic colitis: a retrospective clinical study of 199 Swedish patients.

BACKGROUND: Lymphocytic colitis is characterised by chronic diarrhoea and specific microscopic changes in a macroscopically normal colonic mucosa. We report clinical features and treatment outcome in a large patient cohort. METHODS: Patients were searched for in 24 Swedish gastroenterology clinics. The biopsy material was reassessed using strict histopathological criteria. Clinical data were obtained from medical notes. RESULTS: Lymphocytic colitis was diagnosed in 199 cases. The female:male ratio was 2.4:1. Median age at diagnosis was 59 (48-70) years. The most frequent symptoms were diarrhoea (96%), abdominal pain (47%), and weight loss (41%). The course was chronic intermittent in 30% of patients, chronic continuous in 7%, and a single attack in 63%, and in these cases the disease duration was 6 (4-11) months. Seventy nine (40%) patients reported associated diseases, of which thyroid disorders, coeliac disease, and diabetes mellitus were the most common. In 34 first or second degree relatives of 24 (12%) patients, a family history of ulcerative colitis, Crohn's disease, collagenous colitis, or coeliac disease was reported. Drug induced disease was suspected in 19 (10%) patients. A non-significant peak of disease onset was seen in December-January. More than 80% of treated patients improved on corticosteroids, including budesonide. CONCLUSIONS: A family history of other bowel disorders is a new finding. The sudden onset and single attack of limited duration may support a possible infectious cause in some cases. Drugs may cause lymphocytic colitis.

Aged↗
PubMed2004

Clinical and subclinical intestinal inflammation assessed by the mucosal patch technique: studies of mucosal neutrophil and eosinophil activation in inflammatory bowel diseases and irritable bowel syndrome.

BACKGROUND AND AIMS: There is a clear need for a rapid, simple, safe, and sensitive method of determining the type and intensity of inflammation in the gut mucosa in clinical practice. In this study, we have evaluated the potential of a new method, the mucosal patch technique, in patients with and without apparent gut inflammation, as assessed by conventional diagnostic procedures. SUBJECTS AND METHODS: The technique tested is based on the idea that inflammatory mediators released from the rectal mucosa can be absorbed by and then extracted from cellulose patches brought into contact with the mucosa by use of an instrument with an inflatable balloon. Measurements were performed in healthy controls (n = 16) and in patients with active (n = 19) and inactive ulcerative colitis (UC, n = 8), collagen colitis (CC, n = 12), coeliac disease (n = 13), and irritable bowel syndrome (IBS, n = 13). RESULTS: Inflammatory mediators from neutrophils (myeloperoxidase (MPO)) and eosinophils (eosinophil cationic protein (ECP)) were increased on average 300- and 10-fold, respectively, in patients with active UC compared with healthy controls and were correlated with the endoscopic score. Patients with inactive UC, CC, coeliac disease, and IBS exhibited no endoscopic signs of inflammation. These patient groups had significantly lower levels of MPO and ECP than the active UC group but showed on average a four- to sevenfold increase in MPO compared with healthy controls. CONCLUSION: The mucosal patch technique was well tolerated by patients and easily applied by the investigator. Pronounced neutrophil and eosinophil involvement in UC was demonstrated. With the high sensitivity of the technique, low degree mucosal neutrophil activation could also be quantified in patients with CC and UC in clinical remission. The finding of increased neutrophil involvement in patients with IBS contributes to the pathophysiological ideas of this disease.

Adult↗
PubMed2005

[What is inflammatory bowel disease?].

Inflammatory bowel diseases are chronic conditions of unknown origin that result from continuous or intermittent inflammation of a part of the intestinal wall. The main classic types of IBD are ulcerative colitis, Crohn's disease and indeterminate colitis that cannot be classified accurately as ulcerative colitis or Crohn's disease with pure colonic involvement. The two main subtypes of microscopic colitis, namely lymphocytic and collagenous colitis, fulfill the criteria that define IBD and should be considered as true IBD.

Colon↗
PubMed2005

Activation of nuclear factor kappaB in colonic mucosa from patients with collagenous and ulcerative colitis.

BACKGROUND AND AIMS: Expression of inducible nitric oxide synthase (iNOS) is greatly upregulated in the colonic mucosa of patients with collagenous and ulcerative colitis. As the transcription factor nuclear factor kappaB (NFkappaB) is a major inducer of iNOS gene expression, we compared activation and transcriptional activity of NFkappaB in colonic mucosal biopsies from these patients. PATIENTS: Eight patients with collagenous colitis, six with relapsing ulcerative colitis, and eight with uninflamed bowel were studied. METHODS: NFkappaB DNA binding activity was assessed by electrophoretic mobility shift assay and inhibitor of NFkappaB (IkappaB) kinase (IKK) activity by immunocomplex kinase assay. In vivo recruitment of NFkappaB to the iNOS promoter was determined by chromatin immunoprecipitation analysis and transcriptional activity by NFkappaB gene expression profiling arrays. Cells showing NFkappaB activation were identified by immunohistochemistry. RESULTS: In collagenous and ulcerative colitis, as opposed to uninflamed bowel, IKKbeta activity and strong NFkappaB DNA binding gave rise to activation of identical NFkappaB subunits and recruitment of transcriptionally active p65 to the iNOS promoter. In collagenous colitis, activated NFkappaB was observed only in epithelial cells while up to 10% of lamina propria macrophages showed activation in ulcerative colitis. CONCLUSIONS: In collagenous and ulcerative colitis, colonic mucosal NFkappaB is activated and recruited to the iNOS promoter in vivo via an IKKbeta mediated pathway. As collagenous colitis is not associated with tissue injury, these data challenge the prevailing view that activation of NFkappaB per se mediates tissue injury. Our results suggest that downstream inflammatory reactions leading to tissue damage originate in lamina propria immune cells, as increased NFkappaB activity in collagenous colitis was localised solely in epithelial cells, but present also in macrophages in ulcerative colitis.

Colitis, Collagenous↗
PubMed2005

Collagenous gastritis in a Korean child: a case report.

Collagenous gastritis, a counterpart of collagenous colitis, is an extremely rare disorder. The first case of collagenous gastritis in a Korean boy in his pre-teens who had been receiving treatment for refractory iron deficiency anemia has been reported. The patient had been suffering from intermittent abdominal pain, recurrent blood-tinged vomiting and poor oral intake. The gastric endoscopy revealed diffuse cobblestone appearance of the mucosa with easy touch bleeding throughout the stomach but no abnormalities in the esophagus, duodenum, and colon. Pathologic examination of the gastric biopsies from the antrum, body and cardia showed a subepithelial collagen deposition with entrapped dilated capillaries, moderate infiltrates of lympho-plasma cells and eosinophils of the lamina propria, and marked hypertrophy of the muscularis mucosa. The collagen deposition appeared as discontinuous bands with focally irregular extension into the deeper part of the antral mucosa. It measured up to 150 microm. Helicobacter pylori infection was not detected. The biopsies from the duodenum, esophagus and colon revealed no pathologic abnormalities.

Biopsy↗
PubMed1999

Incidence of collagenous and lymphocytic colitis: a 5-year population-based study.

OBJECTIVE: The incidence of collagenous and lymphocytic colitis is not well known. We sought to assess the incidence of collagenous and lymphocytic colitis in a well-defined population during a 5-yr study period. METHODS: From January 1, 1993, to December 31, 1997, all new patients diagnosed with collagenous or lymphocytic colitis living in the catchment area of the Hospital Mutua de Terrassa (Barcelona, Spain) were identified. Since 1993 all patients with chronic diarrhea were referred for a diagnostic colonoscopy. Multiple biopsy sampling of the entire colon was performed when appearance of the colonic mucosa was grossly normal. RESULTS: Twenty-three cases of collagenous colitis and 37 of lymphocytic colitis were diagnosed. The female:male ratios were 4.75:1 and 2.7:1 for collagenous and lymphocytic colitis, respectively. The mean age at onset of symptoms was 53.4+/-3.2 (range, 29-82) yr for collagenous colitis, and 64.3+/-2.7 (range, 28-87) yr for lymphocytic colitis (p = 0.012). The mean annual incidence per 100,000 inhabitants based on the year of onset of symptoms was 1.1 (95% confidence interval [CI], 0.4-1.7) for collagenous colitis, and 3.1 (95% CI, 2.0-4.2) for lymphocytic colitis. A peak incidence was observed in older women in both diseases. A rate of microscopic colitis of 9.5 per 100 normal-looking colonoscopies performed in patients with chronic watery diarrhea was observed. Normal rectal biopsies were found in 43 % and 8% of patients with collagenous and lymphocytic colitis, respectively. CONCLUSIONS: The incidence of lymphocytic colitis is three times higher than that of collagenous colitis. Microscopic colitis should be considered as a major possibility in the work-up of chronic diarrhea in older women.

Age Factors↗
PubMed1999

[Ticlopidine-induced lymphocytic colitis].

Lymphocytic colitis is a clinico-pathological syndrome characterized by chronic diarrhea, normal endoscopy, diffuse colonic mucosal inflammatory changes. Collagenous colitis is defined by a thickening of the collagen plate. The etiology is unknown but immune disorders have been frequently associated with it and it has been linked with the taking of certain drugs such as nonsteroïd anti-inflammatory drugs or veinotonics. We are reporting a case of microscopic colitis associating both lymphocytic and collagenous colitis, wich induced chronic diarrhea in a 65-year-old man. It appeared after he had taken ticlopidine. Diarrhea stopped after he had discontinuated ticlopidine, and recurred after he resumed taking the drug. Histological damages from lymphocytic colitis improved six month after he had stopped taking ticlopidine. Chronic diarrhea induced by ticlopidine might be caused by lymphocytic colitis.

Aged↗
PubMed2000

Clinical, endoscopic, and histologic spectrum of nonsteroidal anti-inflammatory drug-induced lesions in the colon.

PURPOSE: It has become increasingly clear that nonsteroidal anti-inflammatory drugs may cause damage not only to the upper gastrointestinal tract but also to the small and large intestine. Although the colon may be readily investigated by endoscopy, drug-induced lesions are not well known, probably because they are considered to occur only rarely. In the present study we describe endoscopic, histologic, and gross characteristics of nonsteroidal anti-inflammatory drug-induced colonic damage. Furthermore, pathogenetic mechanisms and therapeutic options are discussed. METHODS: The histories of all patients diagnosed as having nonsteroidal anti-inflammatory drug colitis during the last two years at the department of gastroenterology or the department of pathology at our hospital were reviewed. Endoscopic, histologic, and gross pathologic findings were systematically recorded. In addition, data on duration and type of nonsteroidal anti-inflammatory drug intake and time from onset of symptoms to diagnosis were collected. Therapy and outcome of our patients, if available, are reported. RESULTS: During the study period 11 patients were diagnosed as having nonsteroidal anti-inflammatory drug colitis. Most patients presented with diarrhea with or without blood loss and complained about diffuse abdominal pain. Endoscopy revealed flat ulcers in the entire colon being more severe in the right colon in the three cases with acute onset of diarrhea. In four cases concentric "diaphragm-like" strictures were seen, all located in the right colon. In the remainder endoscopy showed nonspecific erosions and was normal in one patient. Histology revealed findings similar to ischemic colitis. Additionally, in two cases collagenous colitis was found. Diclofenac slow release was the most commonly involved drug. The median time from onset of symptoms to diagnosis was 1.8 (range, 0-11.5) years. CONCLUSIONS: Nonsteroidal anti-inflammatory drug colitis is a clinically significant disease, which may present with diarrhea, anemia, and nonspecific abdominal complaints. Careful history taking, together with awareness of endoscopic and histologic findings, allows a timely diagnosis of this disease.

Adult↗
PubMed2002

Lansoprazole-associated microscopic colitis: a case series.

Lansoprazole is a potent proton pump inhibitor that has been well tolerated with minimal serious adverse events. One of the most commonly reported side effects is diarrhea in 3-8% of study patients. During 1997, approximately 850 veterans at our institution had their proton pump inhibitor converted from omeprazole to lansoprazole because of a formulary change. A number of patients subsequently developed chronic watery diarrhea. While evaluating six of these patients, we discovered microscopic colitis that resolved with discontinuation of lansoprazole. The diarrhea was described as three to 10 loose, nonbloody bowel movements per day with some abdominal cramping. Colonoscopy in five patients and flexible sigmoidoscopy in one patient revealed normal colonic mucosa, but random biopsies all supported microscopic colitis (five cases of lymphocytic colitis and one case of collagenous colitis). Complete symptom resolution occurred in all patients within 4 to 10 days of discontinuing lansoprazole. In all patients, follow-up biopsies demonstrated normalization of the colonic histology. This is the first published case series of patients with microscopic colitis that correlated clinically and histologically with the initiation and discontinuation of lansoprazole.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMedDate not supplied

Inflammatory bowel disease with cytoplasmic-staining antineutrophil cytoplasmic antibody and extensive colitis.

A cohort of 18 patients with inflammatory bowel disease who were characterized by the presence of cytoplasmic-staining antineutrophil cytoplasmic antibody (cANCA) and extensive colitis is reported. Almost half were Indo-Canadians, and atypical perinuclear-staining antineutrophil cytoplasmic antibody was also detected in five (28%), similar to the detection rate for Crohn's disease and other less commonly detected forms of colitis, such as lymphocytic or collagenous colitis. Careful pathological review of all endoscopic biopsies and surgically resected colonic tissues did not reveal evidence of vasculitis or so-called 'palisading' granulomas, which is a typical pathological change of Wegener's granulomatosis, an entity that has been traditionally characterized by the detection of cANCA. This report describes 18 patients with extensive colitis and the seromarker cANCA but without clinical features or histological evidence of vasculitis.

Adolescent↗
PubMedDate not supplied

[Microscopic colitis--more common cause of diarrhea than believed. Biopsies are the only way to diagnosis, drug treatment is effective].

Microscopic colitis, encompassing collagenous and lymphocytic colitis, is a fairly common cause of chronic watery diarrhoea, especially in elderly women. In recent epidemiological studies the annual incidence of each disorder was 4-6/100.000 inhabitants. The aetiology is unknown. The main clinical symptoms are watery diarrhoea, weight loss and abdominal pain. Laboratory analyses are nondiagnostic, and the diagnoses rely on histopathological examination of colonic mucosal biopsies. There is an association to autoimmune diseases such as thyroid disorders, diabetes mellitus, celiac disease and arthritis. Budesonide is the best-documented treatment of collagenous colitis. It is superior to placebo in short-term therapy, but the long-term efficacy is not well studied. The evidence for other therapeutic alternatives such as loperamide, cholestyramine, bismuth subsalicylate, or 5-aminosalicylates is weak. In unresponsive severe disease azathioprine or methotrexate may be tried. There are at present no controlled data on the treatment of lymphocytic colitis. The long-term prognosis of microscopic colitis is good, serious complications are rare and there is no increased mortality.

Age Factors↗
PubMed2001

Collagenous gastritis: a report of six cases.

Collagenous gastritis is an exceptional entity with eight cases documented to date characterized by the presence of a thick subepithelial collagen band associated with an inflammatory infiltrate of the gastric mucosa. The aim of our study was to describe the clinical and histologic characteristics of six new cases of collagenous gastritis. All cases showed a subepithelial collagen band that averaged 30 microm but often measured up to 120 microm. This finding was almost always accompanied by mixed chronic inflammation in the lamina propria and by surface epithelial damage of varying severity. Our study seems to delineate two subsets in patients with collagenous gastritis: 1) collagenous gastritis occurring in children and young adults presenting with severe anemia, a nodular pattern on endoscopy, and a disease limited to the gastric mucosa without evidence of colonic involvement, and 2) collagenous gastritis associated with collagenous colitis occurring in adult patients presenting with chronic watery diarrhea. These findings highlight the fact that subepithelial collagen deposition may be a generalized disease affecting the entire gastrointestinal tract.

Adult↗
PubMed1997

Increased nitric oxide production in collagenous and lymphocytic colitis.

The production of nitric oxide (NO) is increased in active ulcerative colitis and in Crohn's disease. We have studied NO production in collagenous colitis (CC) and lymphocytic colitis (LC), both of which are inflammatory bowel disorders of unknown aetiology. NO levels were measured directly in gas sampled from the colon during colonoscopy. Plasma levels of NO metabolites (nitrate/nitrite) were also measured. Luminal NO levels were more than 100 times higher in patients with CC compared with controls. In addition, plasma levels of nitrate/nitrite were increased in the patients as compared with controls. Measurements of NO directly in the colon or its oxidation products in plasma may be a helpful tool in further understanding the role of NO in the pathophysiology of CC and LC. Moreover, it is tempting to speculate that these measurements could be clinically useful in the diagnosis and therapy monitoring of these two inflammatory bowel diseases.

Adult↗
PubMed1989

A novel enteropathy with partial villous atrophy, microscopic colitis, and pemphigoid change.

Microscopic colitis associated with gluten-resistant partial villous atrophy was documented in a 21-year-old woman with chronic nonbloody diarrhea. Electron microscopic examination of the colonic and duodenal biopsies showed focal separations of basal lamina from cryptal epithelial cells forming subepithelial blebs in which were mast cells and fibroblasts. These morphologic features have not been previously described in any inflammatory bowel disease and are reminiscent of bullous pemphigoid of the skin. The findings suggest that not all cases of microscopic colitis lie within the spectrum of collagenous colitis.

Adult↗
PubMed2005

Microscopic colitis: a retrospective study of clinical presentation in 53 patients.

AIM: To evaluate the relationship between symptoms and microscopic colitis (MC) subtypes: to test whether collagenous colitis (CC) and/or lymphocytic colitis (LC) might be related to both constipation and diarrhea. METHODS: A cohort of patients with independently confirmed typical histopathological changes was investigated. Fifty-three patients with histologically proved MC (46 with CC, 7 with LC) were included. The existence of diarrhea or constipation and the co-existence of autoimmune diseases were also investigated and all data were retrospectively analyzed. RESULTS: Twenty-three (43.39%) of MC patients had chronic constipation (20 in CC, 3 in LC patients). Twenty-four (45.28%) of MC patients had autoimmune disease and the diagnosis of autoimmune disease was always prior to MC. Sjögren's syndrome was associated only with the constipation subgroup. CONCLUSION: The Janus face of MC resembles the subgroups of irritable bowel syndrome. The co-existence of autoimmune diseases and MC is confirmed in both the constipation and diarrhea subgroups.

Adult↗
PubMed1995

[Damages to the large intestine induced by non-steroidal anti-inflammatory agents].

Non-steroidal anti-inflammatory drugs can cause side effects in the large bowel. We describe two cases which illustrate some of the aspects associated with this problem, and briefly outline the different types of side effects encountered, and possible pathogenetic mechanisms. It is emphasized that non-steroidal anti-inflammatory drugs can cause exacerbation of quiescent colitis in patients with inflammatory bowel disease. The use of these drugs in such patients should be very restrictive. Non-steroidal anti-inflammatory drugs can also precipitate de novo colitis. They are also associated with collagenous colitis, non-gangrenous ischemic colitis, complications to diverticular disease, and ulceration of the colon.

Adult↗
PubMed1995

Chronic, unexplained diarrhea: are biopsies necessary if colonoscopy is normal?

OBJECTIVE: We sought to determine the frequency of clinically important histological abnormalities in patients with chronic, unexplained diarrhea who had macroscopically normal colonic endoscopies. METHODS: Of 855 consecutive patients undergoing colonoscopy (595 cases) or flexible proctosigmoidoscopy (260 cases) by one endoscopist, biopsies were taken in 111 cases of unexplained diarrhea of at least 4-6 weeks duration in which the colorectal mucosa appeared grossly normal. All biopsies were blindly reviewed by one pathologist. RESULTS: In this group of patients with macroscopically normal colons, we identified no cases of Crohn's disease or ulcerative colitis or any definite cases of collagenous colitis (CC) or lymphocytic colitis (LC). There was one case classified as "possible CC" and 13 cases classified as "some features of LC". There were five cases of melanosis coli, one case of cytomegalovirus colitis (in an immunosuppressed patient), and one case of radiation injury. Ninety-one cases were classified as no pathological diagnosis or minimal histological change. Patients with abnormal histology were contacted to see if they had persistence or resolution of diarrhea. For the cases of "possible CC" and "some features of LC," diarrhea had resolved spontaneously in the majority. Interesting to note, only one of the five melanosis coli patients admitted to laxative use, raising the question of surreptitious abuse. CONCLUSIONS: We conclude that the yield of biopsies in diarrhea patients with macroscopically normal colons at endoscopy is low. It may be reasonable to obtain biopsies in patients with relatively severe or debilitating symptoms, with diarrhea that sounds "organic" (e.g., nocturnal stools, frequent watery stools, weight loss, elevated sedimentation rate), or in patients who are immunosuppressed. When biopsies are taken at colonoscopy, we suggest taking about six from throughout the colon and placing them into just one specimen container to help minimize costs.

Adult↗