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Miller C, Whitney-Miller C, Ettel MG. Clinical Implications of Microscopic Colitis Isolated to Polyps. Int J Surg Pathol 2024; 32:456-461. [PMID: 37424329 DOI: 10.1177/10668969231185085] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Microscopic colitis is generally identified on random colon biopsies performed for chronic diarrhea, but rarely incidental polyps have histologic features of microscopic colitis. We compared patients with polypoid microscopic colitis to control patients with conventional polyps to determine the implications of polypoid microscopic colitis. Medical records were searched for patients without prior or concurrent microscopic colitis who were found to have polypoid microscopic colitis. For each patient with polypoid microscopic colitis, one patient with conventional polyps was selected as a control. We reviewed the histologic features of each polypoid microscopic colitis specimen, and evaluated endoscopic and clinical findings for polypoid microscopic colitis patients and controls. Twenty-six patients with polypoid microscopic colitis were identified with histologic features of collagenous colitis in 8 patients (31%) and lymphocytic colitis in 18 patients (69%). Polypoid microscopic colitis was unifocal in 14 patients (54%) and multifocal in 12 patients (46%). Patients with polypoid microscopic colitis were older than control patients (median age = 60 years vs 66 years, P = .04). On follow-up 7 patients with polypoid microscopic colitis (33%) developed chronic diarrhea compared to 3 (12%) controls (P = .16). Of patients with follow-up biopsies, 1 patient with polypoid microscopic colitis (13%) and no control patients developed microscopic colitis (P = 1). Polypoid microscopic colitis may be identified in asymptomatic patients and most patients do not develop chronic diarrhea, but some patients with polypoid microscopic colitis develop diarrhea (33% vs 12% in controls) or conventional microscopic colitis on follow-up. Thus pathologists should distinguish polypoid microscopic colitis from conventional microscopic colitis but may inform clinicians of the uncertain association with chronic diarrhea to guide decisions regarding follow-up.
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Affiliation(s)
- Caroline Miller
- Department of Pathology, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Mark G Ettel
- Department of Pathology, University of Rochester Medical Center, Rochester, NY, USA
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González IA, Conrad M, Weinbrom S, Patel T, Kelsen JR, Russo P. Clinicopathologic Characterization of Lymphocytic Colitis in the Pediatric Population. Pediatr Dev Pathol 2024; 27:156-168. [PMID: 38160439 DOI: 10.1177/10935266231215117] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND Lymphocytic colitis (LC) in the pediatric population has been associated with immune dysregulation. METHODS Single-center retrospective study of pediatric LC. RESULTS 50 patients (35 female, 70%) with a median age of 12 years at diagnosis (interquartile range: 5.7-15.8) of LC were identified. At presentation, 11 patients (22%) had malnutrition, 16 (32%) had a known underlying immune dysregulation, 4 (8%) had celiac disease (CD), and none had a diagnosis of inflammatory bowel disease. The most common medications prior to diagnosis were non-steroidal anti-inflammatory drugs, proton pump inhibitor, and selective serotonin reuptake inhibitors (10% each). Colonic biopsies showed a median number of intraepithelial lymphocytes (IELs)/100 epithelial cells of 48 (range: 25-85), and only 10% of cases had neutrophilic cryptitis. Upper gastrointestinal tract findings included lymphocytic esophagitis (4%), and duodenal IELs without and with villous blunting (9% each) (n: 47). Ten patients (23%) had increased IELs in the terminal ileum (n: 43). Treatments including 5-ASA, budesonide, prednisone, and gluten-free diet improved symptoms in <50% of patients (n: 42), and all follow-up colonoscopies showed persistent LC (n: 13). CONCLUSION Our study supports the association of LC with immune-mediated conditions, most commonly celiac disease. Symptomatic improvement was seen in <50% of patients with none of the patients with repeat colonoscopy showing histologic improvement.
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Affiliation(s)
- Iván A González
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Maire Conrad
- Department of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, PA, USA
| | - Sarah Weinbrom
- Department of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, PA, USA
| | - Trusha Patel
- Department of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, PA, USA
| | - Judith R Kelsen
- Department of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, PA, USA
| | - Pierre Russo
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, PA, USA
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Roth B, Ohlsson B. Microscopic colitis found together with celiac disease in a female population is associated with one episode of lymphocytic colitis. BMC Gastroenterol 2024; 24:70. [PMID: 38347511 PMCID: PMC10860280 DOI: 10.1186/s12876-024-03158-2] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 02/04/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Microscopic colitis (MC) is considered a chronic disease associated with autoimmune disease, smoking, and drugs. The aim was to examine the association between MC and celiac disease, adjusted for smoking, considering subtypes and clinical course of the disease in a retrospectively collected female cohort. METHODS Women (n = 240), ≤ 73 years, diagnosed as MC in medical records or pathological registers were invited. One hundred and fifty-eight women accepted to be included. Participants completed a study questionnaire about sociodemographic factors, lifestyle habits, and medical history; the Rome III questionnaire; and the visual analog scale for irritable bowel syndrome (VAS-IBS). Participants were categorized into collagenous colitis (CC) (n = 92) and lymphocytic colitis (LC) (n = 66) or MC with one episode of the disease (n = 70) and refractory MC (n = 88). Presence of IBS-like symptoms were noted. Blood samples were collected and analyzed for anti-transglutaminase antibodies. Differences between groups were calculated and logistic regression was adjusted for smoking habits. RESULTS MC and celiac disease debuted simultaneously in half of the cases. Celiac disease was most prevalent in LC (12.1% vs. 3.3%; p = 0.05) and MC with one episode (12.9% vs. 2.3%; p = 0.01). Anti-transglutaminase antibodies were found in one patient with one episode of MC. Corticosteroid use was most often found in CC (37.0% vs. 21.2%; p = 0.037) and refractory MC (38.6% vs. 20.0%; p = 0.015). Past smokers were most prevalent in patients with one episode of MC (54.3 vs. 29.5%; p = 0.007). Current smoking was the smoking habit with highest prevalence of IBS-like symptoms. When adjusted for smoking habits, celiac disease was associated with LC (OR: 4.222; 95% CI: 1.020-17.469; p = 0.047) and tended to be inversely associated with refractory MC (OR: 0.210; 95% CI: 0.042-1.506; p = 0.058). CONCLUSION Celiac disease is most common in patients with one episode of LC. The question remains whether LC in combination with celiac disease should be classified as celiac disease or two different entities.
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Affiliation(s)
- Bodil Roth
- Department of Internal Medicine, Lund University, Skåne University Hospital, Jan Waldenströms Street 15, Floor 5, 205 02, Malmö, Sweden
| | - Bodil Ohlsson
- Department of Internal Medicine, Lund University, Skåne University Hospital, Jan Waldenströms Street 15, Floor 5, 205 02, Malmö, Sweden.
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Larsson JK, Clarkson S, Sjoberg K. Regional differences in the incidence of lymphocytic and collagenous colitis over time. Scand J Gastroenterol 2023; 58:1445-1452. [PMID: 37599473 DOI: 10.1080/00365521.2023.2248536] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/07/2023] [Accepted: 08/11/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND In microscopic colitis (MC), the incidence has increased over the last decades. The aim of the present study was to determine the incidence of lymphocytic (LC) and collagenous colitis (CC) in the county Skåne (Scania), southern Sweden, during the period 2010-20 with focus both on the temporal and spatial variations. METHODS The MC diagnosis was retrieved from the biopsy registries at the Departments of Pathology. Established diagnostic criteria (increased lymphocyte count, inflammation in lamina propria and in CC a collagen band) were used for diagnosis. Age, gender, date for diagnosis and municipality of residence were retrieved for all patients. RESULTS In total 1985 patients could be identified with a mean age of 62.9 years (SD 15.7) whereof 1415 were women. The incidence for CC was stable with a total age-standardized rate (ASR) per 100 000 person-years of 6.34, (range 4.6-8.1). In LC the ASR was 7.90 (range 1.7-15.2) but increased markedly 2015-20 reaching 15.2 in 2019. Also, the northwest part of the region showed significantly higher ASR:s of LC during the last part of the decade in comparation to the whole region. CONCLUSIONS The incidence of CC was stable during the period while LC differed substantially in a way that indicates that it most probably must be two different disease entities. In LC, in view of the marked and rapid increase, although no definitive explanation could be found, causative environmental factors could be contemplated, why further studies are indicated.
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Affiliation(s)
- Johanna Kristina Larsson
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Gastroenterology and Nutrition, Skåne University Hospital, Malmö, Sweden
| | | | - Klas Sjoberg
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Gastroenterology and Nutrition, Skåne University Hospital, Malmö, Sweden
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Topel G, Cakır E, Aydın I, Dılek FH, Akder Sarı A. Analysis of Clinical and Histopathological Findings in Microscopic Colitis. Turk Patoloji Derg 2022; 38:275-283. [PMID: 35642347 PMCID: PMC10508402 DOI: 10.5146/tjpath.2022.01574] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 03/13/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Microscopic colitis is a chronic inflammatory disorder characterized by a triad of chronic diarrhea, endoscopy without significant abnormality, and distinct histopathological features. Histopathologically, microscopic colitis is divided into 3 subtypes; collagenous colitis, lymphocytic colitis, incomplete microscopic colitis. The main purpose of this study was to analyze the detailed clinicopathological parameters of microscopic colitis cases in the Turkish population. MATERIAL AND METHOD The clinicopathological parameters were evaluated in 53 microscopic colitis cases (37 collagenous colitis, 7 lymphocytic colitis, 9 incomplete microscopic colitis) diagnosed between 2010 and 2019. RESULTS All cases had lymphoplasmacytosis. The presence of ≥20 eosinophils/high power field in the lamina propria was remarkable in 75.7%, 57.1%, and 11.1% of collagenous colitis, lymphocytic colitis, and incomplete microscopic colitis cases, respectively. One of the striking findings was the presence of concomitant Celiac disease in 29% of the lymphocytic colitis cases. In terms of drug use, proton pump inhibitors and nonsteroidal anti-inflammatory drugs were the most commonly used drugs. CONCLUSION The mean age in our series is lower than the literature and a distinct male predominance was observed in lymphocytic colitis and incomplete microscopic colitis, contrary to the literature. These suggest that susceptibility to microscopic colitis may differ between ethnic groups. The presence of overt lymphoplasmacytosis, eosinophilic infiltration and epithelial damage are the microscopic features which should alert the pathologist for the diagnosis of complete microscopic colitis. Given that microscopic colitis is a common treatable cause of chronic diarrhea, awareness of the aforementioned histopathological features is of utmost importance for accurate diagnosis and not to miss incomplete cases.
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Affiliation(s)
- Gozde Topel
- Department of Pathology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Ebru Cakır
- Department of Pathology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Ilgin Aydın
- Department of Pathology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Fatma Husniye Dılek
- Department of Pathology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Aysegul Akder Sarı
- Department of Pathology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
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Windon AL, Almazan E, Oliva-Hemker M, Hutchings D, Assarzadegan N, Salimian K, Montgomery EA, Voltaggio L. Lymphocytic and collagenous colitis in children and adolescents: Comprehensive clinicopathologic analysis with long-term follow-up. Hum Pathol 2020; 106:13-22. [PMID: 32991931 DOI: 10.1016/j.humpath.2020.09.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/20/2020] [Accepted: 09/21/2020] [Indexed: 11/17/2022]
Abstract
Microscopic colitis (MC) is characterized by chronic watery diarrhea, endoscopically normal findings, and abnormal histology. While mostly encountered in adults, pediatric cases are rare and may show varying presentations. Our pathology data system was searched from 1984 to 2019 for patients ≤18 years of age with a lymphocytic colitis (LC) or collagenous colitis (CC) pattern of injury. Twenty-seven cases (23 LC and 4 CC) were retrieved. LC was more prevalent than CC (85% vs 15%, respectively) and affected slightly younger individuals (mean, 9.8 years versus 12.25 years). Immune dysregulation was documented in 11 (41%) patients. Most patients presented with watery diarrhea (n = 26, 96%) and either abdominal pain (n = 18, 67%), nausea/vomiting (n = 5, 19%), flatulence (n = 6, 22%), and/or weight loss (n = 1, 4%). A subset of patients (n = 10, 37%) demonstrated endoscopic abnormalities. Histologically, some patients with LC and CC displayed focal cryptitis or crypt abscess formation (n = 7, 26%) and focally increased crypt apoptosis (n = 9, 33%) in the absence of chronic injury. Clinical follow-up data were available for 23 (85%) patients with variable clinical responses recorded. Only 8 patients experienced complete symptom resolution. Twelve patients (11 LC and 1 CC) had subsequent biopsy material; of which, one developed histologic features of inflammatory bowel disease and another was found to have a CTLA-4 deficiency. Our study shows that pediatric patients with MC may have atypical clinical, histologic, and endoscopic findings and variable clinical responses. Underlying inflammatory and/or genetic conditions may be eventually unmasked, and genetic testing may be helpful in a small subset of patients.
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Affiliation(s)
- Annika L Windon
- Department of Pathology and Laboratory Medicine, The Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD, 21287, USA.
| | - Erik Almazan
- Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD, 21205, USA.
| | - Maria Oliva-Hemker
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, The Johns Hopkins Hospital, 200 N. Wolfe Street, Rubenstein Child Health Building, Baltimore, MD, 21287, USA.
| | - Danielle Hutchings
- Department of Pathology and Laboratory Medicine, The Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD, 21287, USA.
| | - Naziheh Assarzadegan
- Department of Pathology and Laboratory Medicine, The Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD, 21287, USA.
| | - Kevan Salimian
- Department of Pathology and Laboratory Medicine, The Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD, 21287, USA.
| | - Elizabeth A Montgomery
- Department of Pathology and Laboratory Medicine, The Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD, 21287, USA.
| | - Lysandra Voltaggio
- Department of Pathology and Laboratory Medicine, The Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD, 21287, USA.
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Tong YT, Dupont AW, Cash BD, Ertan A, Younes M. Aquaporin-5 Expression Is Reduced in Lymphocytic Colitis. Ann Clin Lab Sci 2020; 50:447-449. [PMID: 32826239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Aquaporin-5 (AQP5) is a member of a family of water channel proteins involved in the bidirectional transfer of water across cell membranes. Lymphocytic colitis (LC) and collagenous colitis (CC) are clinically similar diseases characterized by chronic watery diarrhea in patients with usually unremarkable colonic mucosa on colonoscopy. The aim of this study was to determine whether AQP5 expression in colonic epithelium is altered in LC and CC. METHODS Sections of formalin-fixed and paraffin-embedded colorectal biopsies from three control patients (CTL), 8 patients with chronic non-bloody diarrhea with biopsies negative for active inflammation or significant distortion (CTL-D), 8 patients with LC, and 5 with CC were stained for AQP5 using immunohistochemistry. The staining intensity was scored as 3 (strong), 2 (intermediate), 1 (weak), or 0 (no staining). Statistical analysis was performed using Prism 7 Statistical Soft-ware. RESULTS AQP5 was strongly expressed (score 3) in the epithelial cells in all three CTL cases and all 8 CTL-D cases. In the 5 cases of CC, 3(60%) had score 3 and 2(40%) had score 2, but none had a score of 1 or 0. Of the 8 LC cases, 2(25%) had score 3, 3 had score 2(37.5%), and 3 had score 1(37.5%) (p=0.0031). In the three cases of LC with markedly reduced AQP5 (score 1), enteric steroid treatment did not lead to significant improvement in diarrhea. CONCLUSIONS Colorectal AQP5 expression is reduced in most cases of LC. Markedly reduced AQP5 expression in LC may identify a subset of patients with suboptimal response to enteric steroid treatment. Additional larger studies are needed to confirm these findings.This abstract was presented in part at Digestive Diseases Week in San Diego, CA, May 2019.
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Affiliation(s)
- Yi T Tong
- Department of Pathology and Laboratory Medicine
| | - Andrew W Dupont
- Department of Medicine Section of Gastroenterology, Hepatology and Nutrition and the Ertan Digestive Diseases Center of Excellence, The University of Texas Health Science Center at Houston McGovern Medical School, and Memorial-Hermann Hospital-TMC, Houston, TX, USA
| | - Brooks D Cash
- Department of Medicine Section of Gastroenterology, Hepatology and Nutrition and the Ertan Digestive Diseases Center of Excellence, The University of Texas Health Science Center at Houston McGovern Medical School, and Memorial-Hermann Hospital-TMC, Houston, TX, USA
| | - Atilla Ertan
- Department of Medicine Section of Gastroenterology, Hepatology and Nutrition and the Ertan Digestive Diseases Center of Excellence, The University of Texas Health Science Center at Houston McGovern Medical School, and Memorial-Hermann Hospital-TMC, Houston, TX, USA
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Arévalo F, Monge E, Zurita F, Vergara G, Ramírez R. [Neuroendocrine hiperplasia in linfocitic and ulcerative colitis]. Rev Gastroenterol Peru 2018; 38:345-348. [PMID: 30860505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Some authors have found increase of neuroendocrine cells in microscopic colitis and ulcerative colitis. OBJECTIVE The aim of this study is to evaluate the presence of neuroendocrine cells in ulcerative colitis and lymphocytic colitis and collagenous colitis. MATERIALS AND METHODS Immunohistochemistry was performed to identify neuroendocrine cells through marker chromogranin A (CgA). The study included 10 cases of each diagnosis of Lymphocytic colitis, collagenous colitis and ulcerative colitis. RESULTS There was statistically significant difference in the count of neuroendocrine cells, between lymphocytic colitis and control (p=0.019104), and between ulcerative colitis and controls (p=0.0077). In collagenous colitis there was an increase in neuroendocrine cells but we failed to find statistical differences. CONCLUSION We could observe neuroendocrine cell hyperplasia in lymphocytic colitis and ulcerative colitis compared with controls, which confirm previous studies.
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Affiliation(s)
- Fernando Arévalo
- Servicio Patología, Hospital Nacional Daniel Alcides Carrión. Callao, Perú; Universidad Nacional Mayor de San Marcos. Lima, Perú
| | - Eduardo Monge
- Servicio Gastroenterología, Hospital Nacional Daniel Alcides Carrión. Callao, Perú; Universidad Nacional Mayor de San Marcos. Lima, Perú; Universidad Peruana Cayetano Heredia. Lima, Perú
| | - Fiorella Zurita
- Servicio Patología, Hospital Nacional Daniel Alcides Carrión. Callao, Perú
| | - Greys Vergara
- Servicio Patología, Hospital Nacional Daniel Alcides Carrión. Callao, Perú
| | - Rocío Ramírez
- Servicio Patología, Hospital Nacional Daniel Alcides Carrión. Callao, Perú
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Chojnacki C, Błasiak J, Fichna J, Chojnacki J, Popławski T. Evaluation of Melatonin Secretion and Metabolism Exponents in Patients with Ulcerative and Lymphocytic Colitis. Molecules 2018; 23:molecules23020272. [PMID: 29382152 PMCID: PMC6017024 DOI: 10.3390/molecules23020272] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 01/21/2018] [Accepted: 01/26/2018] [Indexed: 12/15/2022] Open
Abstract
Inflammatory bowel diseases, particularly ulcerative colitis (UC) and lymphocytic colitis (LC), affect many people. The role of melatonin in the pathogenesis of UC is precisely determined, whereas in LC it remains unknown. The aim of this study was to compare the expression of the melatonin-synthesizing enzymes tryptophan hydroxylase (TPH1), arylalkylamine-N-acetyltransferase (AANAT), and N-acetylserotonin methyltransferase (ASMT) in the colonic mucosa and urinary excretion of 6-sulfatoxymelatonin in patients with ulcerative and lymphocytic colitis. The study included 30 healthy subjects (group C), 30 patients with severe ulcerative colitis (group UC), and 30 patients with lymphocytic colitis (group LC). The diagnosis was based on endoscopic, histological, and laboratory examinations. Biopsy specimens were collected from right, transverse, and left parts of the colon. The levels of mRNA expression, TPH1, AANAT, and ASMT were estimated in the colonic mucosa with RT-PCR. The urine concentration of aMT6s was determined by the photometric method. The expression of TPH1, AANAT, and ASMT in colonic mucosa in UC and LC patients was significantly higher than in healthy subjects. Significant differences were found in the urinary aMT6s excretion: group C—13.4 ± 4.8 µg/24 h, group UC—7.8 ± 2.6 µg/24 h (p < 0.01), group LC—19.2 ± 6.1 µg/24 h (p < 0.01). Moreover, a negative correlation was found between fecal calprotectin and MT6s—in patients with UC − r = −0.888 and with LC − r = −0.658. These results indicate that patients with UC and those with LC may display high levels of melatonin-synthesizing enzymes in their colonic mucosa, which could possibly be related to increased melatonin synthesis as an adaptive antioxidant activity.
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Affiliation(s)
- Cezary Chojnacki
- Department of Clinical Nutrition and Gastroenterological Diagnostics, Medical University, 90-647 Lodz, Poland.
| | - Janusz Błasiak
- Department of Molecular Genetics, University of Lodz, 90-647 Lodz, Poland.
| | - Jakub Fichna
- Department of Biochemistry, Medical University of Lodz, 90-647 Lodz, Poland.
| | - Jan Chojnacki
- Department of Clinical Nutrition and Gastroenterological Diagnostics, Medical University, 90-647 Lodz, Poland.
| | - Tomasz Popławski
- Department of Molecular Genetics, University of Lodz, 90-647 Lodz, Poland.
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Högger L, Vavricka S. [Microscopic Colitis]. Praxis (Bern 1994) 2018; 107:1195-1199. [PMID: 30376775 DOI: 10.1024/1661-8157/a003099] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Microscopic colitis (MC) is still an underestimated cause of chronic, non-bloody watery diarrhea. It is typically manifested in elderly patients with a female predominance. The incidence of microscopic colitis has been increasing. The aetiology and pathophysiology remain unclear. Conditions associated with it include autoimmune diseases. There may be a genetic predisposition, as familial cases have been described. As implicated by the name microscopic colitis, the diagnosis is found by histological examination. There are mainly two subtypes, the lymphocytic colitis (LC) and the collagenous colitis (CC). Even if the condition's long-term course is benign, a chronic recurrent course of the symptoms is frequent. Due to the symptoms, there is an impairment of patient's health-related quality of life. A correct diagnosis and therapy is therefore mandatory. The aim of this paper is to create awareness for microscopic colitis.
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MESH Headings
- Adult
- Aged
- Biopsy
- Chronic Disease
- Colitis, Collagenous/diagnosis
- Colitis, Collagenous/etiology
- Colitis, Collagenous/pathology
- Colitis, Lymphocytic/diagnosis
- Colitis, Lymphocytic/etiology
- Colitis, Lymphocytic/pathology
- Colitis, Microscopic/diagnosis
- Colitis, Microscopic/etiology
- Colitis, Microscopic/pathology
- Diagnosis, Differential
- Diarrhea/etiology
- Diarrhea/pathology
- Female
- Humans
- Intestinal Mucosa/pathology
- Male
- Middle Aged
- Quality of Life
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Affiliation(s)
- Lisa Högger
- 1 Klinik für Allgemein-, Viszeral- und Gefässchirurgie, Kantonsspital Baden
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Arévalo F, Vergara G, Ruiz S, Castillo J, Zurita F, Monge E. [Concurrent lymphocytic colitis and microscopic enteritis in patients with chronic diarrhea]. Rev Gastroenterol Peru 2017; 37:340-345. [PMID: 29459804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Lymphocytic colitis and microscopic enteritis are relatively common causes of chronic diarrhea and it is characterized by an intraepithelial lymphocytic infiltrate. There have been no previous reports of coexistence between these 2 pathologies. OBJECTIVE To describe histological and clinical characteristic in patients with coexistence of lymphocytic colitis and microscopic enteritis. MATERIAL AND METHODS All cases with simultaneous diagnosis of lymphocytic duodenosis and lymphocytic colitis were reevaluated during lapse time 2010-2016 in hospital Daniel Carrion. The slides were reviewed by 3 pathologists and clinical information was obtained from clinical records. Expression of CD3 and CD8 was detected in 6 cases by immunohistochemical assays. RESULTS A total of 35 patients with coexistence of lymphocytic duodenitis and lymphocytic colitis were selected of the pathology archives, 80% were females, Anemia was identified in 28.5% of patients. Blastocysitis hominis infestation was identified in 31.8%. The mean intraepithelial lymphocyte CD8 and CD3 positive was 40% in microscopic enteritis, while the mean intraepithelial lymphocyte CD3 positive was 37.2% and CD8 positive was 29.2% Additionally, lymphocytic ileitis was diagnosed in 11 of our cases. Eosinophilic colitis was diagnosed in 9 cases of lymphocytic colitis Conclusion: We found that lymphocytic colitis, microscopic enteritis and even lymphocytic ileitis can coexist in a group of patients with chronic diarrhea. These findings bring the question if this concurrence of both pathologies constituted a more generalized gastrointestinal disorder, involving both the large and the small intestines.
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Affiliation(s)
- Fernando Arévalo
- Servicio de Patología, Hospital Nacional Daniel Alcides Carrión. Callao, Perú; Universidad Nacional Mayor de San Marcos. Lima, Perú
| | - Greys Vergara
- Servicio de Patología, Hospital Nacional Daniel Alcides Carrión. Callao, Perú
| | - Susy Ruiz
- Servicio de Patología, Hospital San Bartolomé. Lima, Perú
| | - Joseph Castillo
- Servicio de Patología, Hospital Nacional Daniel Alcides Carrión. Callao, Perú; Universidad Nacional Mayor de San Marcos. Lima, Perú
| | - Fiorella Zurita
- Servicio de Patología, Hospital Nacional Daniel Alcides Carrión. Callao, Perú
| | - Eduardo Monge
- Universidad Nacional Mayor de San Marcos. Lima, Perú; Servicio de Gastroenterología, Hospital Nacional Daniel Alcides Carrión. Callao, Perú; Universidad Peruana Cayetano Heredia. Lima, Perú
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Rubio CA. Increased Production of Lysozyme Associated with Bacterial Proliferation in Barrett's Esophagitis, Chronic Gastritis, Gluten-induced Atrophic Duodenitis (Celiac Disease), Lymphocytic Colitis, Collagenous Colitis, Ulcerative Colitis and Crohn's Colitis. Anticancer Res 2015; 35:6365-6372. [PMID: 26637845] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The mucosa of the esophagus, the stomach, the small intestine, the large intestine and rectum are unremittingly challenged by adverse micro-environmental factors, such as ingested pathogenic and non-pathogenic bacteria, and harsh secretions with digestive properties with disparate pH, as well as bacteria and secretions from upstream GI organs. Despite the apparently inauspicious mixture of secretions and bacteria, the normal GI mucosa retains a healthy state of cell renewal. To by-pass the tough microenvironment, the epithelia of the GI react by speeding-up cell exfoliation, by increasing peristalsis, eliminating bacteria through secretion of plasma cell-immunoglobulins and by increasing production of natural antibacterial enzymes (lysozyme) and host defense peptides (defensin-5). Lysozyme was recently found up-regulated in Barrett's esophagitis, in chronic gastritis, in gluten-induced atrophic duodenitis (celiac disease), in collagenous colitis, in lymphocytic colitis and in Crohn's colitis. This up-regulation is a response directed towards the special types of bacteria thriving in the microenvironment in each of the aforementioned clinical inflammatory maladies. The purpose of that up-regulation is to protect the mucosa affected by the ongoing chronic inflammation. Bacterial antibiotic resistance continues to exhaust our supply of effective antibiotics. The future challenge is how to solve the increasing menace of bacterial resistance to anti-bacterial drugs. Further research on natural anti-bacterial enzymes such as lysozyme, appears mandatory.
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Affiliation(s)
- Carlos A Rubio
- Department of Pathology, Karolinska Instutute and University Hospital, Stockholm, Sweden
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13
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Affiliation(s)
- Ashish Aggarwal
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University Medical Center, Indianapolis, Indiana
| | - Debra Helper
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University Medical Center, Indianapolis, Indiana
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14
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Tontini GE, Pastorelli L, Spina L, Fabris F, Bruni B, Clemente C, de Nucci G, Cavallaro F, Marconi S, Neurath MF, Neumann H, Tacconi M, Vecchi M. Microscopic colitis and colorectal neoplastic lesion rate in chronic nonbloody diarrhea: a prospective, multicenter study. Inflamm Bowel Dis 2014; 20:882-91. [PMID: 24681653 DOI: 10.1097/mib.0000000000000030] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Lymphocytic and collagenous colitis are emerging as common findings in subjects undergoing colonoscopy for chronic non-bloody diarrhea (CNBD). Data concerning microscopic colitis (MC) are still limited and affected by controversial epidemiological evidences. Recent converging lines of evidence suggest that MC correlates a lower risk of colorectal neoplasia. Accordingly, we prospectively assessed MC prevalence in a multicenter cohort of subjects submitted to colonoscopy for CNBD, thereby defining whether MC influences the risk of colorectal neoplasia. METHODS Consecutive patients with CNBD of unknown origin underwent pan-colonoscopy with multiple biopsies. The prevalence of neoplastic patients in MC was compared with that observed in negative CNBD subjects. RESULTS Among 8006 colonoscopy, 305 subjects were enrolled for CNBD. Patients with CNBD were more likely to be women than men (odds ratio = 1.5; P = 0.001). Histopathology detected high prevalence of MC (16%) with a clear predominance of collagenous colitis (70%). A striking age-dependent rise in MC-associated risk was observed, depicting outstanding differences among varying age groups, as in the number needed to screen 1 new case. Gender distribution was balanced within MC patients (Female/Male = 1.5/1), especially among lymphocytic colitis (Female/Male = 1.2/1). MC patients were negatively associated with the risk of neoplastic polyps compared with negative CNBD subjects (odds ratio = 0.22; P = 0.035). CONCLUSIONS MC is the first cause of CNBD in subjects submitted to colonoscopy. Multiple biopsies are strongly recommended, even in the case of uneventful endoscopic inspection, especially for age ≥40 years. MC has a reduced risk of colorectal neoplasia, suggesting that this model of chronic inflammation plays a protective effect against colorectal carcinogenesis.
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Affiliation(s)
- Gian Eugenio Tontini
- *Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy; †Department of Medicine I, University of Erlangen-Nuremberg, Erlangen, Germany; ‡Department of Biomedical Sciences for Health, University of Milan, Milano, Italy; §Gastroenterology and Digestive Endoscopy Unit, Istituti Clinici Zucchi, Monza, Italy; ‖Pathology and Citodiagnostic Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy; and ¶Medical Department, Chiesi Farmaceutici SpA, Parma, Italy
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15
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Abstract
OBJECTIVE Microscopic colitis (MC) is prevalent in adults investigated for chronic watery diarrhea, yet characterization of pediatric MC is limited. METHODS Our pathology database was searched from 1995 to 2011 for pediatric cases of lymphocytic colitis (LC) or collagenous colitis (CC). Those with diarrhea persisting for >2 weeks and visually normal colonoscopy were accepted as cases. Demographics, laboratory results, medication use within 3 months of presentation, medical and family history of autoimmune disease, and response to treatment were abstracted. RESULTS A total of 27 cases were histologically consistent with MC on biopsy; 5 with concomitant enteric infection or isolated abdominal pain were excluded. Twenty-two cases of MC (female patients, 59%; median age at diagnosis, 15.3 years) were included (19 LC and 3 CC). Two had type 1 diabetes mellitus, 2 were anti-nuclear antibody positive, and 2 had common variable immunodeficiency. Of 20 patients who underwent an esophagogastroduodenoscopy, 1 had collagenous sprue and 4 had celiac disease. One presented after the clearance of recurrent Clostridium difficile infection. Previous drug exposures included nonsteroidal anti-inflammatory drugs (n = 7), proton pump inhibitors (n = 6), and selective serotonin reuptake inhibitors (n = 3). Common symptoms in addition to diarrhea included abdominal pain (77.3%) and weight loss (27.3%). Of 17 patients with follow-up, all of the 8 treated with steroids had some response: 57.1% (4/7) responded to mesalamine and 42.9% (3/7) responded to bismuth subsalicylate. CONCLUSIONS In this cohort of pediatric patients, LC was much more common than CC. As described in adults, we observed associations with celiac disease, type 1 diabetes mellitus, and medications; we additionally saw an association with immunodeficiency. Our patients showed greater response to steroids than mesalamine or bismuth.
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MESH Headings
- Abdominal Pain/etiology
- Abdominal Pain/prevention & control
- Adolescent
- Anti-Inflammatory Agents/therapeutic use
- Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
- Antidiarrheals/therapeutic use
- Child
- Child, Preschool
- Cohort Studies
- Colitis, Collagenous/drug therapy
- Colitis, Collagenous/immunology
- Colitis, Collagenous/pathology
- Colitis, Collagenous/physiopathology
- Colitis, Lymphocytic/drug therapy
- Colitis, Lymphocytic/immunology
- Colitis, Lymphocytic/pathology
- Colitis, Lymphocytic/physiopathology
- Colon/drug effects
- Colon/immunology
- Colon/pathology
- Diarrhea/etiology
- Diarrhea/prevention & control
- Drug Resistance
- Female
- Follow-Up Studies
- Humans
- Lost to Follow-Up
- Male
- Proton Pump Inhibitors/therapeutic use
- Retrospective Studies
- Selective Serotonin Reuptake Inhibitors/therapeutic use
- Weight Loss/drug effects
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Affiliation(s)
- Nirmala P Narla
- *Mayo Medical School †Department of Anatomic Pathology and Laboratory Medicine ‡Division of Gastroenterology and Hepatology §Division of Pediatric Gastroenterology and Hepatology Mayo Clinic, Rochester, MN
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16
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Abstract
BACKGROUND It is unknown whether the subtypes of microscopic colitis (MC) represent distinct nosologic entities or related presentations of the same disease. Our aim was to search for epidemiologic differences among its various histopathologic subtypes. METHODS In a computerized database of 789,568 colon pathology reports, we compared the characteristics of 8,745 MC patients with those of the remaining population. RESULTS MC was diagnosed as three distinct histopathologic subtypes: lymphocytic colitis (LC) in 51 %, collagenous colitis (CC) in 43 %, and incomplete colitis (IC) in 6 % of patients. Only 0.65 % was simultaneously diagnosed with more than one subtype of MC. The prevalence of all three subtypes showed an age-dependent rise, with the average age (SD) being 63.3 (14.3) years in LC, 66.4 (12.1) years in CC, and 67.3 (12.7) years in IC (p < 0.0001). There was a striking female predominance in all three subtypes, the female fraction being 72 % in LC, 82 % in CC, and 79 % in IC (p < 0.0001). All three subtypes showed similar geographic distributions among different US states. They were similarly associated with diarrhea and weight loss, the odds ratios for all MC being 45.92 (43.35-48.63) and 5.12 (4.68-5.60), respectively, compared to control patients without MC. All three subtypes also harbored significantly less colonic adenomas, the overall odds ratio being 0.11 (0.10-0.12). CONCLUSION MC comes in three distinct histopathologic entities, which show striking similarities of their general epidemiologic features. The slight differences in their demographic characteristics could point at varying sets of environmental influences that affect the occurrence of subtypes.
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Affiliation(s)
- Amnon Sonnenberg
- Department of Gastroenterology, Portland VA Medical Center P3-GI, 3710 SW US Veterans Hospital Road, Portland, OR, 97239, USA,
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17
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Kumawat AK, Strid H, Tysk C, Bohr J, Hörnquist EH. Microscopic colitis patients demonstrate a mixed Th17/Tc17 and Th1/Tc1 mucosal cytokine profile. Mol Immunol 2013; 55:355-64. [PMID: 23566938 DOI: 10.1016/j.molimm.2013.03.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 03/13/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND Microscopic colitis (MC) is a chronic inflammatory bowel disorder of unknown aetiology comprising collagenous colitis (CC) and lymphocytic colitis (LC). Data on the local cytokine profile in MC is limited. This study investigated the T helper (Th) cell and cytotoxic T lymphocyte (CTL) mucosal cytokine profile at messenger and protein levels in MC patients. METHODS Mucosal biopsies from CC (n=10), LC (n=5), and CC or LC patients in histopathological remission (CC-HR, n=4), (LC-HR, n=6), ulcerative colitis (UC, n=3) and controls (n=10) were analysed by real-time PCR and Luminex for expression/production of IL-1β, -4, -5, -6, -10, -12, -17, -21, -22, -23, IFN-γ, TNF-α, T-bet and RORC2. RESULTS Mucosal mRNA but not protein levels of IFN-γ and IL-12 were significantly up regulated in CC, LC as well as UC patients compared to controls. Transcription of the Th1 transcription factor T-bet was significantly enhanced in CC but not LC patients. mRNA levels for IL-17A, IL-21, IL-22 and IL-6 were significantly up regulated in CC and LC patients compared to controls, albeit less than in UC patients. Significantly enhanced IL-21 protein levels were noted in both CC and LC patients. IL-6 protein and IL-1β mRNA levels were increased in CC and UC but not LC patients. Increased mucosal mRNA levels of IFN-γ, IL-21 and IL-22 were correlated with higher clinical activity, recorded as the number of bowel movements per day, in MC patients. Although at lower magnitude, IL-23A mRNA was upregulated in CC and LC, whereas TNF-α protein was increased in CC, LC as well as in UC patients. Neither mRNA nor protein levels of IL-4, IL-5 or IL-10 were significantly changed in any of the colitis groups. LC-HR and especially CC-HR patients had normalized mRNA and protein levels of the above cytokines compared to LC and CC patients. No significant differences were found between LC and CC in cytokine expression/production. CONCLUSION LC and CC patients demonstrate a mixed Th17/Tc17 and Th1/Tc1 mucosal cytokine profile.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Case-Control Studies
- Colitis, Collagenous/genetics
- Colitis, Collagenous/immunology
- Colitis, Collagenous/pathology
- Colitis, Lymphocytic/genetics
- Colitis, Lymphocytic/immunology
- Colitis, Lymphocytic/pathology
- Colitis, Microscopic/genetics
- Colitis, Microscopic/immunology
- Colitis, Microscopic/pathology
- Cytokines/biosynthesis
- Cytokines/genetics
- Female
- Humans
- Immunity, Mucosal/genetics
- Male
- Middle Aged
- T-Lymphocytes, Cytotoxic/immunology
- T-Lymphocytes, Cytotoxic/pathology
- Th1 Cells/immunology
- Th1 Cells/pathology
- Th17 Cells/immunology
- Th17 Cells/pathology
- Young Adult
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18
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Jegadeesan R, Liu X, Pagadala MR, Gutierrez N, Butt M, Navaneethan U. Microscopic colitis: Is it a spectrum of inflammatory bowel disease? World J Gastroenterol 2013; 19:4252-4256. [PMID: 23864791 PMCID: PMC3710430 DOI: 10.3748/wjg.v19.i26.4252] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 05/04/2013] [Accepted: 05/17/2013] [Indexed: 02/06/2023] Open
Abstract
Lymphocytic and collagenous colitis are forms of microscopic colitis which typically presents in elderly patients as chronic watery diarrhea. The association between microscopic colitis and inflammatory bowel disease is weak and unclear. Lymphocytic colitis progressing to ulcerative colitis has been previously reported; however there is limited data on ulcerative colitis evolving into microscopic (lymphocytic or collagenous) colitis. We report a series of six patients with documented ulcerative colitis who subsequently were diagnosed with collagenous colitis or lymphocytic colitis suggesting microscopic colitis could be a part of the spectrum of inflammatory bowel disease. The median duration of ulcerative colitis prior to being diagnosed with microscopic colitis was 15 years. We noted complete histological and/or symptomatic remission in three out of six cases while the other three patients reverted back into ulcerative colitis suggesting lymphocytic or collagenous colitis could present as a continuum of ulcerative colitis. The exact molecular mechanism of this histological transformation or the prognostic implications is still unclear. Till then it might be prudent to follow up these patients to assess for the relapse of inflammatory bowel disease as well as for dysplasia surveillance.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Biopsy
- Colitis, Collagenous/classification
- Colitis, Collagenous/diagnosis
- Colitis, Collagenous/pathology
- Colitis, Collagenous/therapy
- Colitis, Lymphocytic/classification
- Colitis, Lymphocytic/diagnosis
- Colitis, Lymphocytic/pathology
- Colitis, Lymphocytic/therapy
- Colitis, Ulcerative/classification
- Colitis, Ulcerative/diagnosis
- Colitis, Ulcerative/pathology
- Colitis, Ulcerative/therapy
- Colon/pathology
- Colonoscopy
- Female
- Humans
- Male
- Middle Aged
- Predictive Value of Tests
- Recurrence
- Remission Induction
- Time Factors
- Treatment Outcome
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19
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Fernández-Bañares F, de Sousa MR, Salas A, Beltrán B, Piqueras M, Iglesias E, Gisbert JP, Lobo B, Puig-Diví V, García-Planella E, Ordás I, Andreu M, Calvo M, Montoro M, Esteve M, Viver JM. Impact of current smoking on the clinical course of microscopic colitis. Inflamm Bowel Dis 2013; 19:1470-6. [PMID: 23552765 DOI: 10.1097/mib.0b013e318281f3cc] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Whether current smoking worsens the clinical course of microscopic colitis (MC) is unknown. The aim was to evaluate the impact of smoking on the clinical course of MC. METHODS One hundred and eighty-four patients (72% women; age, 62.4 ± 1.1 years) with MC (118 collagenous colitis (CC) and 66 lymphocytic colitis (LC) were evaluated (39 of them were current smokers). In all the patients, smoking habits and clinical data at presentation, response to therapy, and clinical relapses during follow-up were prospectively recorded. Risk factors for clinical relapse were studied in 160 patients after a mean follow-up of 28 ± 1 months. Cox regression analysis was used to adjust for confounding variables. RESULTS Age at diarrhea onset was 63.0 ± 1.4 years in nonsmokers and 50.4 ± 2.1 years in current smokers (P < 0.001). There was no significant influence of smoking habit on either clinical symptoms at diagnosis or clinical remission rate. Clinical relapse rate was 25.5% for CC and 29.6% for LC, with the mean relapse-free time 28.8 months (95% confidence interval, 26.3-31.4) for CC and 26.9 months (95% confidence interval, 26-30.3) for LC (P = 0.5). Multivariate analysis showed that age at diagnosis (<50 years versus others; adjusted hazard ratio, 2.8; 95% confidence interval, 1.3-6; P = 0.01) was associated with risk of relapse of CC but not LC. Current smoking was not an independent risk factor for either CC or LC relapse. CONCLUSIONS Active smokers developed MC more than a decade before nonsmokers. Age at diagnosis, but not smoking, was an independent risk factor of relapse in patients with CC.
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20
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Dey I, Beck PL, Chadee K. Lymphocytic colitis is associated with increased pro-inflammatory cytokine profile and up regulation of prostaglandin receptor EP4. PLoS One 2013; 8:e61891. [PMID: 23613969 PMCID: PMC3629156 DOI: 10.1371/journal.pone.0061891] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 03/18/2013] [Indexed: 12/25/2022] Open
Abstract
Microscopic colitis (MC) is comprised of two entities, lymphocytic (LC) and collagenous colitis. Up to 20% of patients with chronic diarrhea that have a normal appearing colonoscopy will be diagnosed with MC. Since MC was first described less than 40 years ago, little is known about the mechanisms involved in disease pathogenesis. Nonsteroidal anti-inflammatory drugs are associated with an increased risk of MC and some reports suggest a dysregulation in prostaglandin production. Recent genome wide screens have found an association between prostaglandin receptor EP4 expression and inflammatory bowel disease; however, EP4 expression has never been studied in MC. The aim of this study was to assess colonic mucosal inflammatory cytokine profiles in patients with LC and to assess expression of the prostaglandin receptor EP4. Colonic mucosal biopsies were obtained from patients undergoing colonoscopy for investigation of diarrhea and in those undergoing colon cancer screening. Following histological assessment, expression of cytokines and the prostaglandin receptor EP4 was analyzed using real-time reverse transcriptase-PCR and immunohistochemistry. Patients with LC had markedly increased mRNA expression for TNF-α, IFN-γ and IL-8 compared to normal controls (p<0.001). No significant differences were noted for IL-1β, IL-4, IL-10 or IL-12/23. Interestingly, those with LC had increased EP4 receptor expression, which positively correlated with increased TNF-α expression. This is the first report to demonstrate that LC is associated with increased TNF-α, INF-γ and IL-8 concurrent with a marked up-regulation of EP4. These findings add to our knowledge on the pathogenesis of LC and may give rise to possible new therapeutic and/or diagnostic tools in the management of MC.
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Affiliation(s)
- Indranil Dey
- Departments of Microbiology, Immunology and Infectious Disease, Health Sciences Centre, Snyder Institute for Chronic Inflammation, University of Calgary, Calgary, Alberta, Canada
| | - Paul L. Beck
- Division of Gastroenterology, Health Sciences Centre, Snyder Institute for Chronic Inflammation, University of Calgary, Calgary, Alberta, Canada
| | - Kris Chadee
- Departments of Microbiology, Immunology and Infectious Disease, Health Sciences Centre, Snyder Institute for Chronic Inflammation, University of Calgary, Calgary, Alberta, Canada
- * E-mail:
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21
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Arévalo F, Aragón V, Montes P, Pérez Narrea T, Monge E. [Eosinophilic and lymphocytic colitis: different histological manifestations of a same process in patients with chronic diarrhea]. Rev Gastroenterol Peru 2013; 33:39-42. [PMID: 23539055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES 1) To determine the prevalence of increased number of eosinophils in colonic mucosa of patients with lymphocytic colitis (LC). 2) To determine the coexistence of eosinophilic colitis (EC) in patients with lymphocytic colitis. MATERIALS AND METHODS slides of adult patients with cronic diarrhea with diagnosis of LC were reviewed between October 2009 and March 2012. The number of eosinophils was quantified. RESULTS Sixty eight patients with LC were included. Elevated eosinophils were found in 76.5 and in 51.4% a diagnosis of EC was established. CONCLUSION 3 out of 4 patients with LC had elevated eosinophils and 1 of 2 patients with LC had criteria for EC.
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22
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Abstract
OBJECTIVE Collagenous colitis (CC) and lymphocytic colitis (LC) are two subtypes of microscopic colitis (MC). Even though they most often are described as different entities they share many clinical and histological features. The aim of this study was to investigate the occurrence of conversion between CC and LC in a larger cohort of patients. MATERIALS AND METHODS All 664 patients in our Pathology register with a diagnosis of CC and LC were scrutinized and those where additional endoscopies had been carried out were included, and their biopsies were re-examined. RESULTS Sixty-five patients (55 women, 10 men, median age 58 years; range 29-86) fulfilled our criteria for inclusion. The primary diagnosis was CC in 47 patients (39 women, 8 men, median age 58 years; range 29-86) and LC in 18 patients (16 women, 2 men, median age 58 years; range 33-74). Conversion occurred in nine of the 65 patients (14%, all women, median age 59 years; range 41-72), three from CC to LC and six from LC to CC. CONCLUSION This study has found that patients can show histological features consistent with both CC and LC over time. These patients could represent a subgroup with a true conversion between two separate entities. Alternatively, MC could be a spectral disease where the varying histological features are manifestations of the natural fluctuation. A third possibility could be that the histological changes reflect different manifestations during the disease course and consequently, the diagnostic criteria could be too vague.
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Affiliation(s)
- Lina Vigren
- Department of Medicine, Division of Gastroenterology, Trelleborg Hospital, Trelleborg, Sweden.
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23
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Rasmussen MA, Munck LK. Systematic review: are lymphocytic colitis and collagenous colitis two subtypes of the same disease - microscopic colitis? Aliment Pharmacol Ther 2012; 36:79-90. [PMID: 22670660 DOI: 10.1111/j.1365-2036.2012.05166.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 04/25/2012] [Accepted: 05/14/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite similar clinical symptoms, collagenous colitis (CC) and lymphocytic colitis (LC) are considered two distinct disease entities. AIM To compare pathoanatomical findings, clinical presentations, risk factors, course of diseases and response to treatment in CC and LC to establish whether they could be subtypes of the same disease, microscopic colitis (MC). METHODS The MEDLINE was searched for CC, LC and MC, and clinical studies of >20 patients were included. Pooled results with 95% confidence intervals were calculated based on the number of patients. RESULTS An abnormal number of intraepithelial lymphocytes are found in 45% (40-50%) with CC, and an abnormal subepithelial collagen band in 16% (13-20%) with LC suggesting a histological overlap. The incidence of CC and LC has increased in parallel. Mean age (CC 63 years; LC 60 years) and clinical presentation are indistinguishable, and females are predominant in CC (77%; 75-79%) as well as LC (68%; 66-70%). Risk factors such as nonsteroid anti-inflammatory drugs consumption CC 39% (36-42%); LC 32% (29-35%) are similar and prevalence of concomitant autoimmune diseases such as coeliac disease (CC 5%; CI: 4-6% and LC 7%; CI: 6-9%) do not differ. Bile acid diarrhoea is highly prevalent in CC (41%; 37-45%) and LC (29%; 24-34%). The effect of budesonide is identical. CONCLUSIONS CC and LC could be considered histological subtypes of the same disease, MC. To facilitate recruitment to clinical trials, all MC patients could be included in future trials and stratified for subtypes.
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MESH Headings
- Anti-Inflammatory Agents/therapeutic use
- Budesonide/therapeutic use
- Colitis, Collagenous/classification
- Colitis, Collagenous/drug therapy
- Colitis, Collagenous/pathology
- Colitis, Lymphocytic/classification
- Colitis, Lymphocytic/drug therapy
- Colitis, Lymphocytic/pathology
- Colitis, Microscopic/classification
- Colitis, Microscopic/drug therapy
- Colitis, Microscopic/pathology
- Diagnosis, Differential
- Humans
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Affiliation(s)
- M A Rasmussen
- Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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24
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Abstract
Microscopic colitides, including lymphocytic (LC) and collagenous colitis (CC), are well-described pathologic conditions. An altered immune response is implicated in the pathogenesis of both entities. CD8+ T lymphocytes (CTLs) secrete interleukin 2 which stimulates proliferation of regulatory T cells (Tregs), and Tregs, in turn, inhibit CTLs, inducing cytotoxic tissue damage. In Tregs, Foxp3 regulates T-cell-related immune responses. The distribution of Tregs and CTLs in microscopic colitides has remained underexplored. To characterize differences in the distribution pattern of Foxp3 in biopsy specimens from patients with LC and CC, 71 colonic biopsy specimens from 69 consecutive patients were categorized into 1 of 3 diagnoses: no significant histopathologic abnormality (NSHPA), LC, or CC. Further immunohistochemical evaluation of all biopsy specimens was conducted using a panel of markers including CD8 and Foxp3. Our study demonstrated that CTL distribution pattern differences exist among these 2 colitides and that differences in the immunologic recruitment of Foxp3+ Tregs in the colonic mucosa correlate with differences in the spectrum of morphologic changes seen in patients with either LC or CC.
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Affiliation(s)
- Shuting Bai
- Department of Pathology and Laboratory Medicine, University of Pennsylvania Hospital, Philadelphia, PA 19104, USA
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25
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Villafuerte-Gálvez J, Sotelo-Olivera MI, Cok J, Piscoya-Rivera A, Huerta-Mercado J. Colonoscopic findings in Peruvian patients with chronic diarrhea. PLoS One 2012; 7:e46690. [PMID: 23094029 PMCID: PMC3475687 DOI: 10.1371/journal.pone.0046690] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 09/04/2012] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To report the colonoscopic and pathological findings in patients with chronic diarrhea from a gastroenterology unit during approximately 3 years in a general teaching hospital located in Lima-Peru. MATERIALS AND METHODS Patients with chronic diarrhea as the motive for colonoscopy from March 2008 to December 2010 were selected from the colonoscopy report computerized database. Colonoscopic findings were registered. Biopsies taken during the procedure were prospectively reviewed. RESULTS 226 patients were included, of which 162 (71.7%) had a colon biopsy available. The average age of the patients was 53.6±16.36. 85.8% of patients were reported to have a normal colon. 14.8% of patients were found to have a normal colonic mucosa or mucosal edema, 35.8% of patients had lymphocytic colitis and 28.4% had paucicelular colitis. CONCLUSIONS The majority of colonoscopies were reported with unremarkable macroscopic findings. Lymphocytic colitis was unusually frequent compared to previous reports.
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26
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Esteve M, Mahadevan U, Sainz E, Rodriguez E, Salas A, Fernández-Bañares F. Efficacy of anti-TNF therapies in refractory severe microscopic colitis. J Crohns Colitis 2011; 5:612-8. [PMID: 22115383 DOI: 10.1016/j.crohns.2011.05.001] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 05/02/2011] [Accepted: 05/02/2011] [Indexed: 12/12/2022]
Abstract
BACKGROUND Refractory microscopic colitis is a rare condition with an unknown rate of occurrence. The efficacy of anti-tumor necrosis factor (TNF) therapy for microscopic colitis has never been reported. Aims 1) To report the frequency of refractory microscopic colitis in the database of the participant hospitals. 2) To describe the therapeutic response to anti-TNF therapy among the refractory cases. METHODS Patients with a histological diagnosis of collagenous colitis and lymphocytic colitis were identified through the Department of Pathology database and the IBD practice database. Patients refractory to medical treatment and with severe symptoms were offered anti-TNF therapy. RESULTS Five of 372 MC patients (1.3%; 95% CI, 0.6 to 3.1) presented with severe symptoms refractory to standard medical therapies. One patient was denied therapy from her insurance carrier. The other 4 received infliximab therapy. The response was excellent after one dose experiencing a 60-90% decrease in bowel movements. Three patients were switched to adalimumab (2 allergic reactions and 1 early loss of response to infliximab). Long-term clinical remission (more than 1 year) was achieved in three cases (2 with adalimumab and 1 with infliximab). One patient on adalimumab had an early loss of response and was referred for colectomy. CONCLUSIONS Microscopic colitis with severe symptoms refractory to standard medical therapy including immunosuppressives is uncommon. In this setting, anti-TNF therapies may be a good option to avoid colectomy.
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Affiliation(s)
- Maria Esteve
- Department of Gastroenterology, Hospital Universitari Mutua Terrassa, Barcelona, Spain
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Calabrese C, Gionchetti P, Liguori G, Areni A, Fornarini GS, Campieri M, Rizzello F. Clinical course of microscopic colitis in a single-center cohort study. J Crohns Colitis 2011; 5:218-21. [PMID: 21575884 DOI: 10.1016/j.crohns.2011.01.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2010] [Revised: 01/18/2011] [Accepted: 01/18/2011] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The long-term natural history of collagenous (CC) and lymphocytic colitis (LC) is not well known. The aims of this study were to evaluate the clinical course of microscopic colitis (MC) and to describe the morbidity evolution of the disease. MATERIAL AND METHODS This study is based on a cohort of 54 patients (35 LC/19 CC), previously included in a randomized trial treated with mesalazine with or without cholestyramine. Patients were followed-up closely during the subsequent 5 years, undergoing clinical, endoscopic and histologic evaluation at least yearly. After this period, they were encouraged to undergo periodical clinical evaluations. RESULTS In a mean follow-up time of 104.9 ± 14.1 months (range 81-138 months) at the end of the therapy, 12 patients (7 LC and 5 CC) relapsed. Of these patients, 4 reported a mild clinical relapse self-treated with antidiarrheal medication. In total 49 patients are clinically free from diarrhea, to date. At multivariate analysis the only predictive factor of relapse seems to be a slow response to treatment. CONCLUSIONS Only a minority of patients with MC had diarrhea more than once a week in a long-term follow-up and the symptom pattern was similar between CC and LC patients.
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Affiliation(s)
- Carlo Calabrese
- Department of Clinical Medicine, University of Bologna, Italy.
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Fernández-Bañares F, Salas A, Esteve M, Pardo L, Casalots J, Forné M, Espinós JC, Loras C, Rosinach M, Viver JM. Evolution of the incidence of collagenous colitis and lymphocytic colitis in Terrassa, Spain: a population-based study. Inflamm Bowel Dis 2011; 17:1015-20. [PMID: 20878755 DOI: 10.1002/ibd.21438] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Accepted: 06/23/2010] [Indexed: 01/08/2023]
Abstract
BACKGROUND Previous studies suggest an increase in the incidence rate of microscopic colitis in recent decades. The aim was to evaluate changes in the population-based incidence rate of microscopic colitis and its subtypes over time in Terrassa, Spain. METHODS This was a prospective study during the period 2004-2008, with a comparison of data from the period 1993-1997. The catchment area was a mixed rural-urban type, with nearly 290,000 inhabitants. All patients with nonbloody chronic diarrhea referred for a diagnostic colonoscopy were included. Multiple biopsy specimen samples were obtained when the macroscopic appearance of the colonic mucosa was normal to rule out microscopic colitis. Crude and adjusted incidence rates based on either the year of diagnosis or the date of onset of symptoms were calculated. RESULTS Forty patients with collagenous colitis (CC) and 32 with lymphocytic colitis (LC) were identified. The mean annual incidence of CC and LC based on the year of onset of symptoms was 2.6/10(5) inhabitants (95% confidence interval [CI], 1.9-3.3), and 2.2/10(5) inhabitants (95% CI, 1.5-3.0), respectively. Incidence rates for CC based on the year of onset of symptoms were significantly higher in the period 2004-2008 than in 1993-1997 (2.6 versus 1.1/10(5) ; P = 0.012). The increase in CC incidence was more marked in women (P = 0.047) than in men (P = 0.19). CONCLUSIONS The annual incidence of CC in Terrassa increased over time, mainly in women. Nevertheless, the rates were much lower than those observed in northern Europe, suggesting that there is a north-south difference in the incidence of microscopic colitis.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Cohort Studies
- Colitis, Collagenous/epidemiology
- Colitis, Collagenous/etiology
- Colitis, Collagenous/pathology
- Colitis, Lymphocytic/epidemiology
- Colitis, Lymphocytic/etiology
- Colitis, Lymphocytic/pathology
- Colitis, Microscopic/epidemiology
- Colitis, Microscopic/etiology
- Colitis, Microscopic/pathology
- Colonoscopy
- Female
- Humans
- Incidence
- Male
- Middle Aged
- Prognosis
- Prospective Studies
- Spain/epidemiology
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Affiliation(s)
- Fernando Fernández-Bañares
- Department of Gastroenterology and Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Catalonia, Spain.
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Datta I, Brar SS, Andrews CN, Dupre M, Ball CG, Buie WD, Beck PL. Microscopic colitis: a review for the surgical endoscopist. Can J Surg 2009; 52:E167-E172. [PMID: 19865548 PMCID: PMC2769103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2008] [Indexed: 05/28/2023] Open
Abstract
Microscopic colitis (MC) is an inflammatory condition of the colon distinct from Crohn disease or ulcerative colitis that can cause chronic diarrhea as well as cramping and bloating. Although it was first described 30 years ago, awareness of this entity as a cause of diarrhea has only become more widespread recently. Up to 20% of adults with chronic diarrhea who have an endoscopically normal colonoscopy may have MC. Endoscopic and radiological examinations are usually normal, but histology reveals increased lymphocytes in the colonic mucosa, which typically cause watery nonbloody diarrhea. Treatment is initially supportive but can include corticosteroids and immunomodulatory therapy for resistant cases. Since surgeons perform a large number of colonoscopies and sigmoidoscopies to assess diarrhea, it is important to be aware of this disease and to look for it with mucosal biopsy in appropriate patients.
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Affiliation(s)
| | | | | | - Marc Dupre
- Department of Pathology, University of Calgary, Calgary, Alta., and the
| | - Chad G. Ball
- Department of Surgery, Grady Memorial Hospital, Atlanta, Ga
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31
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Abstract
Few randomized, controlled trials have investigated the efficacy of pharmacological treatment for lymphocytic colitis. data from a new randomized, placebo-controlled trial have demonstrated the efficacy of budesonide in inducing remission of this disease; this study is an important contribution to this field.
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32
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Turhan A, Lin M, Lee GS, Miele LF, Tsuda A, Konerding MA, Mentzer SJ. Vascular microarchitecture of murine colitis-associated lymphoid angiogenesis. Anat Rec (Hoboken) 2009; 292:621-32. [PMID: 19382226 DOI: 10.1002/ar.20902] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In permissive tissues, such as the gut and synovium, chronic inflammation can result in the ectopic development of anatomic structures that resemble lymph nodes. These inflammation-induced structures, termed lymphoid neogenesis or tertiary lymphoid organs, may reflect differential stromal responsiveness to the process of lymphoid neogenesis. To investigate the structural reorganization of the microcirculation involved in colonic lymphoid neogenesis, we studied a murine model of dextran sodium sulfate (DSS)-induced colitis. Standard 2-dimensional histology demonstrated both submucosal and intramucosal lymphoid structures in DSS-induced colitis. A spatial frequency analysis of serial histologic sections suggested that most intramucosal lymphoid aggregates developed de novo. Intravital microscopy of intravascular tracers confirmed that the developing intramucosal aggregates were supplied by capillaries arising from the quasi-polygonal mucosal plexus. Confocal optical sections and whole mount morphometry demonstrated capillary networks (185 +/- 46 microm diameter) involving six to ten capillaries with a luminal diameter of 6.8 +/- 1.1 microm. Microdissection and angiogenesis PCR array analysis demonstrated enhanced expression of multiple angiogenic genes including CCL2, CXCL2, CXCL5, Il-1b, MMP9, and TNF within the mucosal plexus. Intravital microscopy of tracer particle flow velocities demonstrated a marked decrease in flow velocity from 808 +/- 901 microm/sec within the feeding mucosal plexus to 491 +/- 155 microm/sec within the capillary structures. We conclude that the development of ectopic lymphoid tissue requires significant structural remodeling of the stromal microcirculation. A feature of permissive tissues may be the capacity for lymphoid angiogenesis.
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Affiliation(s)
- Aslihan Turhan
- Laboratory of Adaptive and Regenerative Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
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Joo M, Shim SH, Chang SH, Kim H, Chi JG, Kim NH. Nodular lymphoid hyperplasia and histologic changes mimicking celiac disease, collagenous sprue, and lymphocytic colitis in a patient with selective IgA deficiency. Pathol Res Pract 2009; 205:876-80. [PMID: 19286327 DOI: 10.1016/j.prp.2009.02.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2008] [Revised: 01/22/2009] [Accepted: 02/09/2009] [Indexed: 12/17/2022]
Abstract
Selective IgA deficiency is the most common primary immunoglobulin deficiency. The clinical manifestations of selective IgA deficiency, including gastrointestinal (GI) complications, are rare and typically milder than those seen with common variable immunodeficiency or X-linked agammaglobulinemia. We present a rare case of selective IgA deficiency that shows a number of interesting histological features in the GI tract, including diffuse nodular lymphoid hyperplasia involving the entire small and large intestine, celiac disease-like and collagenous sprue-like changes in the small intestine, as well as lymphocytic colitis pattern. However, this patient had no particular GI symptoms suggestive of celiac sprue or microscopic colitis. These findings suggest that the GI tract in patients with selective IgA deficiency can show peculiar histologic changes that mimic celiac disease, collagenous sprue, or lymphocytic colitis, which may be a pattern of injury related to infection or immunoglobulin immunodeficiency-associated autoimmune phenomena.
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Affiliation(s)
- Mee Joo
- Department of Pathology, Inje University Ilsan Paik Hospital, 2240 Daewha-dong, Ilsanseo-gu, Goyang-si, Gyeonggi-do 411-706, Republic of Korea.
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34
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van der Wouden EJ, Karrenbeld A, Kleibeuker JH, Dijkstra G. Microscopic colitis: an unfamiliar but treatable disease. Neth J Med 2009; 67:41-45. [PMID: 19299845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Chronic diarrhoea is a frequent complaint in clinical practice. Microscopic colitis is the cause of this symptom in 10% of these cases and the prevalence is rising. To exclude microscopic colitis a colonoscopy with multiple biopsies of different regions of the colon is mandatory. A sigmoidoscopy alone is insufficient. Two histopathological types of microscopic colitis can be distinguished: collagenous colitis and lymphocytic colitis. Nowadays, there is sufficient evidence to recommend budesonide as the first-choice treatment. Bismuth can also be recommended, but this drug is not easily available in the Netherlands. Evidence of efficacy of other drugs is scant.
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35
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Meining A, Schwendy S, Becker V, Schmid RM, Prinz C. In vivo histopathology of lymphocytic colitis. Gastrointest Endosc 2007; 66:398-99, discussion 400. [PMID: 17521648 DOI: 10.1016/j.gie.2006.12.027] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2006] [Accepted: 12/19/2006] [Indexed: 12/10/2022]
Affiliation(s)
- Alexander Meining
- II Medical Department, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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36
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Janczewska I, Stål P, Sandstedt B. [Transformation of microscopic colitis to inflammatory bowel disease]. Lakartidningen 2007; 104:1597-8. [PMID: 17564268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
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37
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Abstract
Autoimmune hepatitis is a rare, chronic inflammatory disorder which has been associated with a number of other auto-immune conditions. However, there are no reports in the medical literature of an association with microscopic (lymphocytic) colitis. We report the case of a 53-year-old woman with several autoimmune conditions, including lymphocytic colitis, who presented with an acute hepatitis. On the basis of the clinical features, serology, and histopathology, we diagnosed autoimmune hepatitis. To our knowledge, this is the first report of autoimmune hepatitis in association with lymphocytic colitis, and lends support to the theory of an autoimmune etiology for lymphocytic colitis.
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Affiliation(s)
- Edmond M Cronin
- Department of Gastroenterology, Cork University Hospital, Wilton, Cork, Ireland.
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38
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Fekih M, Ben Hriz F, Sassi A, Matri S, Filali A, Boubaker J. [Microscopic colitis. A 20 cases series]. Tunis Med 2006; 84:403-6. [PMID: 17039729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
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.
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Affiliation(s)
- Monia Fekih
- Service de Gastro-entérologie A. Hôpital la Rabtu, Tunis
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39
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Abstract
A typical symptom of microscopic colitis (MC) is chronic watery diarrhea with normal endoscopic findings and characteristic inflammatory changes in histopathology. Treatment of the disease is mainly empiric. MC has two main subtypes: lymphocytic colitis and collagenous colitis. There are also untypical histopathological forms of MC: MC with giant cells, MC not otherwise specified (NOS) and cryptal lymphocytic coloproctitis. Some other histopathological changes in MC have been observed, especially Paneth cell hyperplasia or epithelial degeneration. Eosinophilic colitis, acute colitis, amyloidosis, ulcerative colitis and Crohn's disease should be taken into consideration in differential diagnosis. The most reliable biopsy material for histopathological examination are samples obtained from transverse colon. Some studies proved that treatment of MC makes it possible to reduce not only clinical, but also histopathological, manifestations.
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Affiliation(s)
- Łukasz Liszka
- Department of Pathomorphology, Medical University of Silesia, Katowice, Poland
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40
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Abstract
AIM To find out the role of bacteria as a possible etiological factor in lymphocytic colitis. METHODS Twenty patients with histopathological diagnosis of lymphocytic colitis and 10 normal controls were included in this study. Colonoscopic biopsies were obtained from three sites (hepatic and splenic flexures and rectosigmoid region). Each biopsy was divided into two parts. A fresh part was incubated on special cultures for bacterial growth. The other part was used for the preparation of histologic tissue sections that were examined for the presence of bacteria with the help of Giemsa stain. RESULTS Culture of tissue biopsies revealed bacterial growth in 18 out of 20 patients with lymphocytic colitis mostly Escherichia coli (14/18), which was found in all rectosigmoid specimens (14/14), but only in 8/14 and 6/14 of splenic and hepatic flexure specimens respectively. In two of these cases, E coli was associated with proteus. Proteus was found only in one case, Klebsiella in two cases, and Staphylococcus aureus in one case. In the control group, only 2 out of 10 controls showed the growth of E coli in their biopsy cultures. Histopathology showed rod-shaped bacilli in the tissue sections of 12 out of 14 cases with positive E coli in their specimen's culture. None of the controls showed these bacteria in histopathological sections. CONCLUSION This preliminary study reports an association between E coli and lymphocytic colitis, based on histological and culture observations. Serotyping and molecular studies are in process to assess the role of E coli in the pathogenesis of lymphocytic colitis.
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Affiliation(s)
- Thanaa Ea Helal
- Department of Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
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41
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Mkhitarian EE, Parkhomenko IG, Solnyshkova TG. [Morphological characteristics of chronic colitis in workers of gas-processing industry]. Arkh Patol 2006; 68:39-40. [PMID: 16752508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Surgical and biopsy material from 76 patients who had been working for a long time at Orenburg gas-processing factory was investigated. Group 1 consisted of 36 workers with classic lymphocytic colitis. Group 2 (40 men) had diarrhea with blood, pains in the abdomen, loss of weight, ulcers at colonoscopy, atypical variants of lymphocytic colitis at colonoscopy. These variants may result in the ulceration leading to inevitable surgery.
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42
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Hilmer SN, Heap TR, Eckstein RP, Lauer CS, Shenfield GM. Microscopic colitis associated with exposure to lansoprazole. Med J Aust 2006; 184:185-6. [PMID: 16489905 DOI: 10.5694/j.1326-5377.2006.tb00184.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2005] [Accepted: 11/07/2005] [Indexed: 11/17/2022]
Affiliation(s)
- Sarah N Hilmer
- Royal North Shore Hospital, Pacific Highway, St Leonards, NSW 2065, Australia.
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43
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Abstract
Lymphocytic colitis (LC) and collagenous colitis (CC), both known as microscopic colitis (MC), are uncommon entities with increasing incidence as more clinicians take biopsies from macroscopically normal colons and as pathologists use more rigorous diagnostic criteria to be confident of the diagnosis. Information on the incidence of this type of colitis is limited and based on reported cases. The purpose of this work is to estimate the incidence of LC and CC in reviewed routine colonoscopies. We reviewed 2815 colonoscopies performed at a tertiary referral center with an open-access service using restricted histological criteria in order to establish the frequency rate of LC and CC in routine colonoscopic biopsy material. Cases suspicious for MC were stained with Masson's trichrome or Congo red stain and immunohistochemically for lymphocytes, where appropriate. Review of routine colonoscopic biopsies showed that MC is underreported in our colonoscopic material. Incidence rates of LC and CC (0.9 and 0.4, respectively) were based on morphological assessment of colonoscopic biopsies using stringent criteria together with clinical data and after differentiation with other lesions which can mimic MC. The 10.2% rate of this type of colitis in patients with chronic watery diarrhea indicates the necessity to consider these lesions in older individuals with diarrhea and normal endoscopical colonic mucosa.
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Affiliation(s)
- Kaz Jaskiewicz
- Departments of Pathology, University Medical School of Gdansk, Debinki 7, 80211 Gdansk, Poland.
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44
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Madisch A, Bethke B, Stolte M, Miehlke S. Is there an association of microscopic colitis and irritable bowel syndrome-A subgroup analysis of placebo-controlled trials. World J Gastroenterol 2005; 11:6409. [PMID: 16425407 PMCID: PMC4355777 DOI: 10.3748/wjg.v11.i41.6409] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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45
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Béchade D, Desramé J, Raynaud JJ, Coutant G, Algayres JP. [Lymphocytic colitis following administration of mianserine]. Rev Med Interne 2005; 27:78-80. [PMID: 16260071 DOI: 10.1016/j.revmed.2005.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2005] [Accepted: 09/09/2005] [Indexed: 11/22/2022]
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Abstract
BACKGROUND The etiology of lymphocytic colitis, a microscopic colitis syndrome, has remained elusive. Because 1) many infectious enteritides exhibit seasonal variability in incidence and 2) a few investigators have proposed some infectious mechanism in lymphocytic colitis, our aim was to determine if any variability in symptom onset existed among lymphocytic colitis patients diagnosed at our institution. STUDY We identified 71 nonduplicated, consecutive patients with lymphocytic colitis over a 4-year period using rigorous clinicopathologic inclusion criteria: 1) chronic watery diarrhea, 2) endoscopically normal colon, 3) no evidence for celiac sprue or drug-induced colitis, 4) diffuse colitis with increased intraepithelial lymphocytes of at least 10 lymphocytes per 100 epithelial cells, 5) evidence of surface epithelial damage, and 6) no significant neutrophilic infiltrates, architectural distortion of the mucosa, or subepithelial collagen deposits. The date of diagnosis was corrected for month of onset of symptoms. RESULTS The distribution of month of onset of symptoms showed a statistically significant (chi test of homogeneity, P = 0.0008) temporal variability and seasonal incidence pattern with excess cases during summer and fall and a paucity of cases during colder months. CONCLUSIONS To our knowledge, this is the first study to examine systematically and report a significant seasonal incidence pattern of lymphocytic colitis. Our observations may support a potential link to an infectious source in lymphocytic colitis.
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Affiliation(s)
- P Rocco LaSala
- Department of Pathology, University of Vermont College of Medicine, 89 Beaumont Avenue, Burlington, VT 05405, USA
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47
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Pohl C, Eidt S, Kruis W. [Microscopic colitis]. Dtsch Med Wochenschr 2005; 130:1962-7. [PMID: 16123901 DOI: 10.1055/s-2005-872611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- C Pohl
- Innere Abteilung, St. Elisabeth Krankenhaus, Köln.
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48
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Löfberg R. [Microscopic colitis more and more frequent. Increased knowledge starts revealing the truth about this "clinical rarity"]. Lakartidningen 2005; 102:2200-1. [PMID: 16145877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Robert Löfberg
- Institutionen för Medicin, Karolinska Institutet, Karolinska Universitetssjukhuset Solna och IBD-enheten, Sophiahemmet, Stockholm.
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49
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Tysk C, Bohr J, Olesen M, Eriksson S, Järnerot G. [Microscopic colitis--more common cause of diarrhea than believed. Biopsies are the only way to diagnosis, drug treatment is effective]. Lakartidningen 2005; 102:2210-4. [PMID: 16145878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
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.
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MESH Headings
- Age Factors
- Aged
- Anti-Inflammatory Agents/therapeutic use
- Antidiarrheals/therapeutic use
- Biopsy
- Chronic Disease
- Colitis, Collagenous/complications
- Colitis, Collagenous/drug therapy
- Colitis, Collagenous/pathology
- Colitis, Lymphocytic/complications
- Colitis, Lymphocytic/drug therapy
- Colitis, Lymphocytic/pathology
- Colitis, Microscopic/complications
- Colitis, Microscopic/diagnosis
- Colitis, Microscopic/drug therapy
- Colitis, Microscopic/epidemiology
- Colon/pathology
- Diagnosis, Differential
- Diarrhea/diagnosis
- Diarrhea/drug therapy
- Diarrhea/epidemiology
- Diarrhea/etiology
- Female
- Humans
- Immunosuppressive Agents/therapeutic use
- Incidence
- Intestinal Mucosa/pathology
- Male
- Middle Aged
- Sex Factors
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Affiliation(s)
- Curt Tysk
- Sektionen för gastroenterologi, medicinska kliniken, Orebro universitet.
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Abstract
Microscopic colitis is defined as a syndrome of chronic watery diarrhea with a chronic inflammatory cell infiltrate in the colonic mucosa but without significant abnormalities at colonoscopy. It encompasses at least two histopathologic entities (ie, collagenous and lymphocytic colitis). The recognition and characterization of microscopic colitis has markedly changed the approach to the evaluation and management of chronic diarrhea. The histologic features of collagenous and lymphocytic colitis are well known to most pathologists. By considering the clinical history and symptoms, the pathologist should be able to reach the correct diagnosis in most cases. However, the spectrum of morphologic changes associated with watery diarrhea syndrome appears to be broader than originally thought. Morphologic changes more often associated with chronic inflammatory bowel disease or even chronic ischemic or infectious colitis have been noted in patients with clinically established microscopic colitis. The data presented in this article suggest that microscopic colitis is a heterogeneous entity, which includes both classic and "atypical" forms. Problems arise when cases do not fit the usual pattern or lack some of the findings that are expected. Pathologists should be aware of the presence of atypical forms of microscopic colitis.
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MESH Headings
- Algorithms
- Animals
- Celiac Disease/complications
- Colitis, Collagenous/metabolism
- Colitis, Collagenous/pathology
- Colitis, Lymphocytic/immunology
- Colitis, Lymphocytic/pathology
- Colitis, Microscopic/classification
- Colitis, Microscopic/complications
- Colitis, Microscopic/etiology
- Colitis, Microscopic/pathology
- Collagen/metabolism
- Diagnosis, Differential
- Enterocolitis, Pseudomembranous/pathology
- Epithelial Cells/pathology
- Giant Cells/pathology
- Humans
- Inflammatory Bowel Diseases/complications
- Intestinal Mucosa/immunology
- Intestinal Mucosa/pathology
- Lymphocytes/immunology
- Lymphocytes/pathology
- Phlebitis/complications
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Affiliation(s)
- Fuju Chang
- Department of Histopathology, St. Thomas' Hospital, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom.
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