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PubMed2002

Effect of fasting on diarrhoea in collagenous colitis.

BACKGROUND/AIM: Diarrhoea in collagenous colitis has been considered as secretory though the pathophysiology has been studied thoroughly in only a few patients. The result of fasting is one way to distinguish between secretory and osmotic diarrhoea. Our aim was to investigate the effect of fasting on diarrhoea in collagenous colitis. METHODS: Fourteen patients with collagenous colitis were admitted to the hospital for investigation. All were female. Five of these did not have diarrhoea during admission and were excluded. Stools were examined for weight, electrolytes, pH, fat and osmolality during a period on a normal diet and during fasting. RESULTS: During the fasting period the faecal weight was significantly reduced from median 757 (440-3,198) to 191 (22- 2,197) g. The faecal sodium concentration was also reduced, though not significantly, during fasting from median 65 (29-85) to 45 (19-88) mmol/l. The osmotic gaps varied according to the method of calculation applied. CONCLUSIONS: The data indicate that the cause of the diarrhoea in collagenous colitis could be multifactorial. In some patients an osmotic factor dominates and in others a secretory factor, while in some patients a combination of both seems to exist.

Aged↗
PubMed1987

Chronic colitis with thickening of the subepithelial collagen layer (collagenous colitis): histopathologic findings in 15 patients.

The histopathologic features of collagenous colitis were studied in 14 women and one man. All but one patient presented with chronic watery diarrhea: 10 had a history of thyroid disease or unspecified arthritis. All 15 patients showed characteristic thickening of the subepithelial collagen layer (SCL) in colorectal biopsy specimens, but in the distal colorectum the thickening was sometimes absent or borderline. Patchy or diffuse injury to the surface epithelium was seen in all cases and was independent of SCL thickening. The injured surface epithelium was infiltrated by lymphocytes and variably by eosinophils and neutrophils, causing it to resemble the surface epithelial injury seen in the small intestine in celiac disease. Crypts were commonly infiltrated by lymphocytes but without associated epithelial injury. The lamina propria in all patients was expanded by lymphocytes, plasma cells, and eosinophils. Neutrophilic cryptitis was seen in seven patients but was usually sparse. Watery diarrhea abated in eight patients treated with corticosteroids or sulfasalazine and was often paralleled by restoration of surface epithelium, reduction in surface epithelial lymphocytes, diminished SCL thickening, and reduced lamina propria eosinophils. Therapy did not consistently alter other inflammatory changes. The possible role of autoimmunity in collagenous colitis should be investigated because of the following circumstantial evidence: the overwhelming female predominance; the frequent presence of possible immunologically mediated disorders such as thyroid and joint disease; the resemblance of surface epithelial changes to those in celiac disease; and the response to corticosteroids.

Adult↗
PubMed1996

Collagenous colitis: pathogenesis and management.

INTRODUCTION: Collagenous colitis is a rare disease of unknown etiology that primarily affects middle-aged women. It presents with chronic watery diarrhea and thickening of the subepithelial collagen layer of the colonic mucosa in the absence of endoscopic abnormalities. PURPOSE: This study was undertaken to review the current literature on clinical course, pathology, diagnosis, and current management of collagenous colitis. RESULTS: Collagenous colitis is an inflammatory disease of the colon, clinically characterized by a waxing and waning course of watery diarrhea, an inflammatory infiltration of the colonic mucosa, and a thickening of the subepithelial collagen layer. Its pathogenesis remains unclear, but there is evidence for an inflammatory process triggered possibly by an uncommon luminal agent. Diagnosis is established by colonic biopsies; in the setting of normal colonic mucosa, the disorder is primarily managed medically with virtually no role for surgery. CONCLUSIONS: Pathogenesis of collagenous colitis remains unclear. Current data favor an inflammatory etiology, possibly involving an initiating luminal insult. Guidelines for diagnosis are being established, and medical treatment options are variably effective in the majority of cases. Very unusual refractory cases may benefit from surgical management.

Biopsy↗
PubMed1998

Collagenous colitis and Yersinia enterocolitica infection.

Collagenous colitis is a rare clinical and pathological entity characterized by watery diarrhea and deposition of collagen beneath the surface epithelium of the colon. Its etiology is unknown. We present a careful retrospective clinicopathological analysis of six patients with collagenous colitis diagnosed at our hospital during a three-year period. Three of the patients had had a Yersinia enterocolitica infection, detected by stool culture and elevated serum antibody titers, preceding the diagnosis of collagenous colitis. Four patients had duodenal villous atrophy, which in two patients was refractory to a gluten-free diet. We propose that Yersinia enterocolitica infection may be a triggering factor for the development of collagenous colitis in some cases. Duodenal villous atrophy not responding to gluten withdrawal is common in association with collagenous colitis.

Adult↗
PubMed1990

[Collagenous colitis].

The features of collagenous colitis are briefly summarized on the basis of 24 own patients and a review of the literature. Collagenous colitis is a rare diarrheal disease first described in 1976. The hallmark of this syndrome consists in a thickened layer of subepithelial collagen in the entire colon. Clinically patients present with longstanding, watery diarrhea. Laboratory tests, radiology and colonoscopy are all normal. Therefore the diagnosis is only established, if an alert colonoscopist takes biopsies out of an endoscopically normal appearing mucosa. There is no specific treatment, but patients usually respond to symptomatic therapy with antidiarrheal drugs. Microscopic colitis may represent an early stage of collagenous colitis.

Adult↗
PubMed1982

[Collagenous colitis (author's transl)].

Collagenous colitis, reported four times until now, is characterised histologically by subepithelial tape-like collagen deposits in the rectum and colon. On endoscopy the mucosa appears normal or slightly oedematous. The main symptom is chronic watery diarrhoea without admixture of blood. The cause of diarrhoea is thought to be defective absorption of electrolytes in the colon as a consequence of the pathological collagen deposition. Using endoscopic, histological and electron microscopic findings two further cases of so-called collagenous colitis could be detected. In one of the two female patients chronic watery diarrhoea occurred connected time-wise with the administration of an H2 receptor antagonist. In addition, a clearly increased pancreatic polypeptide (PP) in serum was demonstrated without proof of an endocrinologically active (pancreatic) tumour.

Colitis↗
PubMed2002

Collagenous colitis associated with lansoprazole.

BACKGROUND: Collagenous colitis is a diarrheal illness of unknown cause. The purpose of this report is to describe a case of collagenous colitis related to lansoprazole exposure. STUDY: Case report. RESULTS: A patient is described who developed clinical and pathologic findings of collagenous colitis during treatment with lansoprazole and omeprazole. Symptoms of diarrhea and histopathologic abnormalities resolved after drug withdrawal and recurred with re-exposure to lansoprazole. CONCLUSIONS: The observations are compatible with collagenous colitis or lymphocytic colitis associated with exposure to lansoprazole.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1990

Familial occurrence of collagenous colitis. A report of two families.

Collagenous colitis is a rare condition characterized clinically by chronic diarrhea and histologically by a thickened subepithelial collagenous band in colonic biopsies in an endoscopically normal colon. Familial occurrence of collagenous colitis has to our knowledge never been described. Here we report two families in which two first-degree related members suffered from collagenous colitis. In one family, two sisters were affected by chronic diarrhea and autoimmune disorders such as thyroid disease, rheumatoid arthritis, and pernicious anemia. Collagenous colitis was diagnosed in one of these sisters, based on colonic biopsies. Colonic biopsies of the other sister showed microscopic colitis. Review of colonic biopsies of this patient taken 11 years earlier, however, showed definite histological features of collagenous colitis. In the other family, in a father and son, both with diarrhea for several years but not suffering from any other diseases, a diagnosis of collagenous colitis was made on colonic biopsies. Human leukocyte antigen (HLA) typing showed that only the HLA A2 antigen was present in all 4 patients.

Adult↗
PubMed1987

Collagenous colitis: a clinicopathologic correlation.

Collagenous colitis is an unusual cause of chronic, watery diarrhea. To characterize this disease, we reviewed biopsy specimens and the clinical records of 17 patients (9 women and 8 men) with this diagnosis. Intermittent diarrhea with symptom-free intervals lasting years was found in 7 of the 17 patients. Two patients had incapacitating arthralgias, and nine had a mild weight loss. Collagen deposition beneath the surface epithelium formed a continuous layer in 11 but was discontinuous in 5 of the 16 patients who had undergone rectal or colonic biopsies at our institution. The thickness of the collagen band was variable (maximum, 93 microns). The symptoms of the patients did not correlate with the thickness of the collagen layer. Variability in collagen thickness may be related to disease phase and increases the need to obtain multiple biopsy specimens from the sigmoid colon and rectum. The optimal treatment for collagenous colitis is difficult to determine because three of six patients treated only symptomatically in our study had resolution of their diarrhea.

Adult↗
PubMed1989

Lymphocytic (microscopic) colitis. Clinicopathologic study of 18 patients and comparison to collagenous colitis.

Lymphocytic colitis, formerly called microscopic colitis, is a clinicopathologic syndrome with chronic watery diarrhea and diffuse mucosal inflammatory changes with prominent intraepithelial lymphocytes. The 18 lymphocytic colitis patients studied presented with chronic watery diarrhea at a mean age of 53.8 +/- 17 years (+/- 1 SD). Roentgenographic, endoscopic, and culture data were not diagnostic. In patients tested, there was a high prevalence of arthritis (82%) and autoantibodies (50%) but no increase in frequency of histocompatibility antigens associated with well-defined autoimmune disease (DR3, B8). Lymphocytic colitis patients were compared to 21 patients with collagenous colitis. Similarities included age, symptomatology, and nondiagnostic radiographic and endoscopic studies. However, the sex distribution was statistically different, with an equal male-to-female ratio in lymphocytic colitis and female predominance (80%) in collagenous colitis. Other differences included dissimilar histocompatibility phenotypes and collagen band on biopsies of collagenous but not lymphocytic colitis. These findings suggest that lymphocytic and collagenous colitis may be related yet distinct disorders.

Adult↗
PubMed2002

Yersinia species in collagenous colitis: a serologic study.

BACKGROUND: The etiology of collagenous colitis is unknown. An infectious cause seems a possibility, and in a recent report three out of six patients with collagenous colitis were shown to have had an infection with Yersinia enterocolitica. The aim was to investigate the occurrence of Yersinia antibodies in collagenous colitis. METHODS: Sera from 32 collagenous colitis patients and 17 healthy controls were analysed for antibodies against Yersinia virulence proteins. RESULTS: Collagenous colitis patients had Yersinia antibodies more often than the controls, 9 having a positive and 4 an intermediate antibody score of the 32 patients. In comparison, I out of 17 controls had a positive and 2 an intermediate antibody score, which represents a strong, although not significant, trend (P = 0.078). CONCLUSION: The data showed that Yersinia antibodies are more common in collagenous colitis patients than in healthy controls. In some cases, Yersinia might have been the triggering event in the development of collagenous colitis.

Adult↗
PubMed1997

Collagenous colitis: histopathology and clinical course.

OBJECTIVES: Collagenous colitis is a chronic diarrheal disease characterized by a normal or near-normal mucosa endoscopically and microscopic inflammation in the lamina propria, surface epithelial injury and a thick subepithelial collagen layer. The symptoms of collagenous colitis vary in duration and intensity, and long periods of remission have been described, but long-term follow-up data are limited. Our goal was to determine the natural clinical history of collagenous colitis and to determine whether there was a relationship between histopathologic changes and course of disease. METHODS: Cases were identified at the University of Michigan Hospitals using surgical pathology records before 1992. All charts, including medical records from other hospitals, were reviewed, and a telephone interview was conducted with each locatable patient (pt). Biopsy specimens were reviewed by two pathologists for degree of collagen layer thickness, epithelial damage, and inflammation. RESULTS: There were 31 patients (26 F, 5 M) with a mean age of 66 yr (range 33-83) and a mean duration of symptoms of 5.4 yr at the time of diagnosis. Of the 31 patients, 18 (56%) had some form of arthritis, and 22 (71%) were using NSAIDS regularly at the time of diagnosis. Follow-up interviews were conducted at least 2 yr after diagnosis (mean 3.5 yr, range 2-5 yr) with 27 of 31 patients (3 could not be located, 1 died). Two definable groups of patients were identified: (1) those with either spontaneous or treatment-related symptom resolution (63%), and (2) those with ongoing or intermittent symptoms requiring at least intermittent therapy (37%). There was no significant difference between the two groups with regard to sex, age, associated diseases, and use of medications. Patients with symptom resolution (mean duration 3.1 yr) had been treated with antidiarrheals (6), sulfasalazine (3), discontinuation of NSAIDS (3), reversal of jejunoilial bypass (1), or nothing (4). Those with ongoing symptoms experienced a wide range of symptom severity. Two required only antidiarrheals, but five required or failed steroids, azathioprine, or sandostatin. There was no significant difference in collagen thickness, epithelial damage, and inflammation between the two groups, but Paneth cell metaplasia was seen more often in those with ongoing symptoms. In 24 of 27 patients, diagnostic changes were present in left-sided biopsies. CONCLUSIONS: In our cohort of patients, 63% had lasting resolution of symptoms after a mean 3.5 yr follow-up. There was a high incidence of arthritis and NSAID use in our population, but there was no relationship between these entities and clinical course or histology. Initial histology, except possibly for Paneth cell metaplasia, did not reliably predict severity or course of disease. Finally, although variable in clinical presentation, treatment-free remissions are common in collagenous colitis.

Adult↗
PubMed1998

Enteropathic arthritis in association with collagenous colitis.

A 46-year-old man simultaneously developed chronic seronegative non destructive oligoarthritis and chronic watery diarrhoea. Biopsies from the colorectal mucosa showed a thickened subepithelial collagen layer consistent with collagenous colitis. Collagenous colitis should be added to the list of causes of enteropathic arthritis.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2005

Progression of collagenous colitis to Crohn's disease.

Collagenous colitis is a condition usually characterized by watery diarrhoea, macroscopically normal colonic mucosa and a typically thickened subepithelial collagen band on histological examination. It is rare in children, and coexistence with other inflammatory bowel diseases has been reported only rarely. We describe a case of diarrhoea presenting in infancy subsequently proved to be collagenous colitis that progressed to the typical features of Crohn's disease.

Child, Preschool↗
PubMed1991

[Collagen colitis--a clinical entity of relevance].

Collagenous colitis is a clinical and pathological entity characterized by chronic watery diarrhea and deposition of collagen beneath the surface epithelium of the large intestine. By colonoscopy and barium enema the colon appears normal. The laboratory tests give usually normal results. 75% of the patients are middle-aged women with a mean age around 50 years. The etiology of the disease is still unknown. An association with various autoimmune diseases has been suggested, but was never proven. Up to now, it is not clear whether the collagenous colitis is a distinct entity or only an epi-phenomenon of another disease which leads to thickening of the collagen layer. Collagenous colitis is diagnosed if all other diseases with chronic watery diarrhea are excluded. A specific treatment is not known. Symptomatic treatment with bulk and antidiarrheal drugs improves the symptoms of most of the patients.

Colitis↗
PubMed2005

Collagenous colitis and lymphocytic colitis: patient characteristics and clinical presentation.

OBJECTIVE: Collagenous colitis and lymphocytic colitis (collectively known as microscopic colitis) are characterized by chronic diarrhea, normal endoscopic and radiologic findings, and typical findings on histologic examination of colonic tissue. The purpose of this study was to define the background characteristics of patients with microscopic colitis, as well as to present symptoms, coexistent autoimmune diseases, and a possible association with the use of non-steroidal anti-inflammatory drugs (NSAIDs) and ticlopidine. MATERIAL AND METHODS: A retrospective chart review was carried out on all cases of collagenous colitis and lymphocytic colitis diagnosed at a single center from July 1992 to July 2002. RESULTS: Of the 104 patients identified, 66 had collagenous colitis, 35 had lymphocytic colitis, and 3 were diagnosed with both disorders at different times. The mean age of patients was 64 years (26-88 years), with a female:male ratio of 4.8:1. The most common presenting symptoms were diarrhea (95%), weight loss (41%), abdominal pain (40%), fecal urgency (29%), and nocturnal stools (22%). Autoimmune disease was diagnosed in 29% of patients, 35% were using an NSAID, and 2% were using ticlopidine. CONCLUSIONS: Collagenous colitis and lymphocytic colitis occur more often in females than in males, at a wide age range, with a mean in the seventh decade. Certain symptoms are characteristic, but are not specific to these disorders. There may be an association with the presence of a coexistent autoimmune disorder and the use of drugs such as NSAIDs.

Adult↗