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Vijayvargiya P, Izundegui DG, Calderon G, Tawfic S, Batbold S, Saifuddin H, Duggan P, Melo V, Thomas T, Heeney M, Beyde A, Miller J, Valles K, Oyemade K, Brant JF, Atieh J, Donato LJ, Camilleri M. Increased Fecal Bile Acid Excretion in a Significant Subset of Patients with Other Inflammatory Diarrheal Diseases. Dig Dis Sci 2022; 67:2413-2419. [PMID: 33886031 PMCID: PMC9290750 DOI: 10.1007/s10620-021-06993-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 04/08/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Increased fecal bile acid excretion (IBAX) occurs in a third of patients with functional diarrhea. AIMS To assess the prevalence of IBAX in benign inflammatory intestinal and colonic diseases presenting with chronic diarrhea. METHODS All patients with known inflammatory diseases or resections who underwent 48 h fecal fat and BA testing for chronic diarrhea at a single center were included. Quiescent disease was based on clinical evaluation and serum, endoscopic and imaging studies. IBAX was defined by: > 2337 µmol total BA/48 h; or primary fecal BAs > 10%; or > 4% primary BA plus > 1000 µmol total BA /48 h. Demographics, fecal weight, fecal fat, stool frequency and consistency were collected. Nonparametric statistical analyses were used for group comparisons. RESULTS Sixty patients had celiac disease (51 quiescent, 9 active), 66 microscopic colitis (MC: 34 collagenous, 32 lymphocytic), 18 ulcerative colitis (UC), and 47 Crohn's disease (CD). Overall, fecal fat, 48 h stool weight, frequency and consistency were not different among subgroups except for inflammatory bowel disease (IBD) based on disease location. Almost 50% patients with celiac disease and MC had IBAX, with a greater proportion with increased primary fecal BA. Among UC patients, rates of IBAX were higher with pancolonic disease. A high proportion of patients with ileal resection or CD affecting ileum or colon had IBAX. IBAX was present even with quiescent inflammation in UC or CD. CONCLUSIONS A significant subset of patients with MC, quiescent celiac disease and IBD had increased fecal BA excretion, a potential additional therapeutic target for persistent diarrhea.
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Affiliation(s)
- Priya Vijayvargiya
- Clinical Enteric Neuroscience Translational and Epidemiological Research (CENTER), Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St. S.W. Charlton Bldg., Rm. 8-110, Rochester, MN 55905, USA
| | - Daniel Gonzalez Izundegui
- Clinical Enteric Neuroscience Translational and Epidemiological Research (CENTER), Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St. S.W. Charlton Bldg., Rm. 8-110, Rochester, MN 55905, USA
| | - Gerardo Calderon
- Clinical Enteric Neuroscience Translational and Epidemiological Research (CENTER), Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St. S.W. Charlton Bldg., Rm. 8-110, Rochester, MN 55905, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | - Jessica Atieh
- Clinical Enteric Neuroscience Translational and Epidemiological Research (CENTER), Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St. S.W. Charlton Bldg., Rm. 8-110, Rochester, MN 55905, USA
| | - Leslie J. Donato
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
| | - Michael Camilleri
- Clinical Enteric Neuroscience Translational and Epidemiological Research (CENTER), Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St. S.W. Charlton Bldg., Rm. 8-110, Rochester, MN 55905, USA
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Abstract
Gastric biopsies are routinely obtained from patients with symptoms related to the gastrointestinal tract and, as a result, a variety of histologic changes are observed in patients with or without endoscopic evidence of mucosal injury. Although Helicobacter pylori-related gastritis is still common, several other patterns of mucosal injury are increasingly encountered. These patterns of injury are classified based on the nature and distribution of inflammation, location of epithelial cell injury, presence of crystal or pigment deposition, and/or other unique features. This article discusses each of these patterns and provides a differential diagnosis for each.
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Abstract
BACKGROUND Perforation of the colon occurring during or shortly following colonoscopy or barium enema is a rare complication of collagenous colitis (CC). "Spontaneous" perforation in CC, in which no instigating factor is identified, is even less common, with only five cases reported to date. We report herein an additional case of spontaneous perforation in previously undiagnosed CC and review the clinical and pathological features of previously reported cases. CASE PRESENTATION An 80 year old woman presented to the emergency department with abdominal pain preceded by approximately one month of frequent non-bloody diarrhea. Abdominal CT showed parietal thickening of the colon at the splenic flexure with pneumatosis and signs of perforation. Segmental resection was performed. Pathologic examination showed the microscopic findings typical of CC complicated by several deep ulcers and perforation. One day following discharge from hospital abdominal pain and frequent non-bloody diarrhea recurred. The patient was managed conservatively and treated with oral budesonide with resulting resolution of symptoms. CONCLUSIONS Spontaneous perforation is a rare and serious complication of CC. All patients to date have been female. In contrast to procedure-related perforation, which favors the right colon, spontaneous perforation in CC has in all cases involved the left colon. Knowledge of spontaneous perforation as a potential complication of previously undiagnosed CC may be helpful in the evaluation and management of patients presenting with colonic perforation, especially those with risk factors for CC.
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Affiliation(s)
- Andrew Mitchell
- Department of Anatomic Pathology and Cytology, Maisonneuve-Rosemont Hospital, 5415 Boulevard de L’Assomption, Montreal, Quebec H1T 2X1 Canada
| | - Alexandre Dugas
- Department of Radiology, Maisonneuve-Rosemont Hospital, 5415 Boulevard de L’Assomption, Montreal, Quebec H1T 2X1 Canada
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Ellingson D, Miick R, Chang F, Hillard R, Choudhary A, Ashraf I, Bechtold M, Diaz-Arias A. Diagnostic Yield of Microscopic Colitis in Open Access Endoscopy Center. Gastroenterology Res 2011; 4:139-142. [PMID: 27942330 PMCID: PMC5139724 DOI: 10.4021/gr339e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2011] [Indexed: 11/18/2022] Open
Abstract
Background The diagnostic yield in open access endoscopy has been evaluated which generally support the effectiveness and efficiency of open access endoscopy. With a few exceptions, diagnostic yield studies have not been performed in open access endoscopy for more specific conditions. Therefore, we conducted a study to determine the efficiency of open access endoscopy in the detection of microscopic colitis as compared to traditional referral via a gastroenterologist. Methods A retrospective search of the pathology database at the University of Missouri for specimens from a local open access endoscopy center was conducted via SNOMED code using the terms: “microscopic”, “lymphocytic”, “collagenous”, “spirochetosis”, “focal active colitis”, “melanosis coli” and “histopathologic” in the diagnosis line for the time period between January 1, 2004 and May 25, 2006. Specimens and colonoscopy reports were reviewed by a single pathologist. Results Of 266 consecutive patients with chronic diarrhea and normal colonoscopies, the number of patients with microscopic disease are as follows: Lymphocytic colitis (n = 12, 4.5%), collagenous colitis (n = 17, 6.4%), focal active colitis (n = 15, 5.6%), and spirochetosis (n = 2, 0.4%). Conclusions The diagnostic yield of microscopic colitis in this study of an open access endoscopy center does not differ significantly from that seen in major medical centers. In terms of diagnostic yield, open access endoscopy appears to be as effective in diagnosing microscopic colitis.
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Affiliation(s)
- Derek Ellingson
- Department of Pathology and Anatomical Sciences, University of Missouri-Columbia, One Hospital Drive, Columbia, MO 65212, USA
| | - Ronald Miick
- Department of Pathology and Anatomical Sciences, University of Missouri-Columbia, One Hospital Drive, Columbia, MO 65212, USA
| | - Faye Chang
- Department of Pathology and Anatomical Sciences, University of Missouri-Columbia, One Hospital Drive, Columbia, MO 65212, USA
| | - Robert Hillard
- Department of Pathology and Anatomical Sciences, University of Missouri-Columbia, One Hospital Drive, Columbia, MO 65212, USA
| | - Abhishek Choudhary
- Department of Internal Medicine-Gastroenterology, University of Missouri-Columbia, Five Hospital Drive, Columbia, MO 65212, USA
| | - Imran Ashraf
- Department of Internal Medicine-Gastroenterology, University of Missouri-Columbia, Five Hospital Drive, Columbia, MO 65212, USA
| | - Matthew Bechtold
- Department of Internal Medicine-Gastroenterology, University of Missouri-Columbia, Five Hospital Drive, Columbia, MO 65212, USA
| | - Alberto Diaz-Arias
- Department of Pathology and Anatomical Sciences, University of Missouri-Columbia, One Hospital Drive, Columbia, MO 65212, USA
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