Collagenous colitis

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Collagenous colitis
Classification and external resources

Micrograph of collagenous colitis. H&E stain.
DiseasesDB2955
eMedicinemed/1351
MeSHD046729
 
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Collagenous colitis
Classification and external resources

Micrograph of collagenous colitis. H&E stain.
DiseasesDB2955
eMedicinemed/1351
MeSHD046729

Collagenous colitis is an inflammatory colonic disease with peak incidence in the 5th decade of life, affecting women more than men. Its clinical presentation involves watery diarrhea, usually in the absence of rectal bleeding. It is often classified under the umbrella entity microscopic colitis, along with a related condition, lymphocytic colitis. Although it was previously considered a rare diagnosis, recent studies have shown microscopic colitis is responsible for 4–13% of patients who are investigated for chronic diarrhea.

Contents

Diagnosis

On colonoscopy, the mucosa of the colon typically looks normal, but biopsies of affected tissue usually show deposition of collagen in the lamina propria, which is the area of connective tissue between colonic glands. Radiological tests, such as a barium enema are typically normal.

Symptoms

Microscopic colitis causes watery intermittent diarrhea with greater than 10 bowel movements per day. Some patients report nocturnal diarrhea, abdominal pain, dehydration and weight loss. Rare complications may include mucosal atrophy with long standing collagenous colitis. Though this is a mild condition, colitis patients report a significantly diminished quality of life.

Causes

The exact cause of collagenous colitis is unknown, but the effects of non-steroidal anti-inflammatory drugs such as diclofenac are commonly implicated.[citation needed] The other group of agents most commonly associated with collagenous colitis are the selective serotonin reuptake inhibitors used in the treatment of depression. The use of nonsteroidal antiinflammatory drugs (NSAID), has been clinically linked to collagenous colitis. Other recently linked drugs include: ticlopidine, proton pump inhibitors (PPI), and statins.

Smoking has also been characterized as a risk factor for collagenous colitis.

Treatment

Treatment of collagenous colitis is often challenging, and many agents have been used therapeutically:

Pilot investigational studies have shown some evidence of possible benefit for both Boswellia serrata extract and specific strains of probiotics in the treatment of collegenous colitis, although larger sample sizes are needed to confirm the results.[1][2][3]

Disease associations

An association between collagenous colitis and celiac disease has been reported, but there is no evidence that dietary restrictions used in celiac disease management are of benefit in collagenous colitis therapy. Between 20-60% of patients with collagenous colitis have been reported as having one or more autoimmune disorders including rheumatoid arthritis and thyroid disease.

There have also been reports of an association between collagenous colitis and lymphoma.

See also

References

  1. ^ Madisch A, Miehlke S, Eichele O, Mrwa J, Bethke B, Kuhlisch E, Bästlein E, Wilhelms G, Morgner A, Wigginghaus B, Stolte M. (2007 Dec). "Boswellia serrata extract for the treatment of collagenous colitis. A double-blind, randomized, placebo-controlled, multicenter trial.". Int J Colorectal Dis. (22(12):2): 1445–51. doi:10.1007/s00384-007-0364-1. PMID 17764013. 
  2. ^ Wildt S, Munck LK, Vinter-Jensen L, Hanse BF, Nordgaard-Lassen I, Christensen S, Avnstroem S, Rasmussen SN, Rumessen JJ. (2006 May). "Probiotic treatment of collagenous colitis: a randomized, double-blind, placebo-controlled trial with Lactobacillus acidophilus and Bifidobacterium animalis subsp. Lactis.". Inflamm Bowel Dis. (12(5)): 395–401. doi:10.1097/01.MIB.0000218763.99334.49. PMID 16670529. 
  3. ^ Tromm A, Niewerth U, Khoury M, Baestlein E, Wilhelms G, Schulze J, Stolte M. (2004 May). "The probiotic E. coli strain Nissle 1917 for the treatment of collagenous colitis: first results of an open-label trial.". Z Gastroenterol. (42(5)): 365–9. doi:10.1055/s-2004-812709. PMID 15136935.