|
1
|
Abstract
Microscopic colitis (MC) is a chronic inflammatory disease that affects the older population. Its clinical presentation includes a variety of gastrointestinal manifestations. The main symptom is chronic watery, nonbloody diarrhea. The disease has a female predominance. The diagnosis might be challenging since the symptoms are similar to other differential diagnoses, such as celiac disease, irritable bowel syndrome, Crohn's disease, bacterial overgrowth, and infectious colitis. The golden diagnostic tool for diagnosis is performing colonoscopy to obtain the colonic biopsy, which demonstrates the characteristic histological evidence needed for diagnosis. The treatment starts with an accurate diagnosis and trial of any possible offending medications. Alternatively, there are many medications, such as bismuth or budesonide, which are very effective in treating this disease. The primary objective of this detailed review is to enhance knowledge and understanding of this condition among healthcare providers to guide them with detailed information regarding epidemiology, clinical presentation, diagnosis, and appropriate management. In the assessment of individuals presenting with persistent chronic diarrhea, it is essential for healthcare providers to consider MC as a probable differential diagnosis.
Collapse
Affiliation(s)
- Khalid I AlHussaini
- Department of Internal Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, SAU
| |
Collapse
|
|
2
|
Ito K, Nakatutumi K, Oofuti Y, Otomo Y. Colon perforation due to collagenous colitis: A case report. Clin Case Rep 2023; 11:e7862. [PMID: 37720705 PMCID: PMC10500050 DOI: 10.1002/ccr3.7862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 07/29/2023] [Accepted: 08/11/2023] [Indexed: 09/19/2023] Open
Abstract
Collagenous colitis (CC) is generally benign, and serious complications are rare. It is important to note that spontaneous perforation of CC is a possible complication. In the case of colon perforation of unknown origin, CC should be considered.
Collapse
Affiliation(s)
- Kei Ito
- Trauma and Acute Critical Care CenterTokyo Medical and Dental University Hospital of MedicineTokyoJapan
| | - Keita Nakatutumi
- Trauma and Acute Critical Care CenterTokyo Medical and Dental University Hospital of MedicineTokyoJapan
| | - Yuko Oofuti
- Trauma and Acute Critical Care CenterTokyo Medical and Dental University Hospital of MedicineTokyoJapan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care CenterTokyo Medical and Dental University Hospital of MedicineTokyoJapan
- Department of Acute Critical Care and Disaster Medicine, Graduate School of Medical and Dental SciencesTokyo Medical and Dental UniversityTokyoJapan
| |
Collapse
|
|
3
|
Sadamitsu T, Ueda T, Boku E, Tanaka T, Yokoyama T, Yoshimura A. Spontaneous colonic perforation with collagenous colitis in an elderly patient. Clin J Gastroenterol 2022; 15:1083-1087. [PMID: 36251247 DOI: 10.1007/s12328-022-01707-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 09/20/2022] [Indexed: 12/01/2022]
Abstract
Collagenous colitis (CC) is a variant of microscopic colitis that causes chronic, non-bloody, and watery diarrhea. The natural history of CC is generally benign and serious complications are rare. Perforation, especially spontaneous perforation, is a particularly rare complication. A 90-year-old woman presented with acute abdominal pain. She was diagnosed with peritonitis due to colonic perforation, and partial colectomy was performed. Macroscopic findings showed well-circumscribed longitudinal ulcer, and a pathological examination revealed descending colon perforation with CC. She had no history of examination and the case was considered to be spontaneous. The postoperative course was uneventful and she had no recurrence of CC after changing from the suspected drug (lansoprazole) to an H2-blocker. The characteristics of perforation by CC are characteristic longitudinal ulcer and micro-perforation. If it can be diagnosed accurately, conservative treatment may be an option. In spontaneous cases, the history of medication and the site of perforation may assist in this decision.
Collapse
Affiliation(s)
- Tomomi Sadamitsu
- Department of Surgery, Minami-Nara General Medical Center, 8-1 Yoshino-gun, Oyodo-cho, 638-8551, Japan
| | - Takeshi Ueda
- Department of Surgery, Minami-Nara General Medical Center, 8-1 Yoshino-gun, Oyodo-cho, 638-8551, Japan.
| | - Eitetsu Boku
- Kawakami Village National Health Insurance Kawakami Clinic, 1334-23 Sako, Kawakami-mura, Yoshino-gun, 639-3553, Japan
| | - Tetsuya Tanaka
- Department of Surgery, Minami-Nara General Medical Center, 8-1 Yoshino-gun, Oyodo-cho, 638-8551, Japan
| | - Takashi Yokoyama
- Department of Surgery, Minami-Nara General Medical Center, 8-1 Yoshino-gun, Oyodo-cho, 638-8551, Japan
| | - Atsushi Yoshimura
- Department of Surgery, Minami-Nara General Medical Center, 8-1 Yoshino-gun, Oyodo-cho, 638-8551, Japan
| |
Collapse
|
|
4
|
Fedor I, Zold E, Barta Z. Microscopic colitis in older adults: impact, diagnosis, and management. Ther Adv Chronic Dis 2022; 13:20406223221102821. [PMID: 35813189 PMCID: PMC9260565 DOI: 10.1177/20406223221102821] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/28/2022] [Indexed: 11/18/2022] Open
Abstract
Microscopic colitis (comprising lymphocytic and collagenous colitis, albeit an incomplete variant is gaining recognition as well) is a chronic, immune-mediated inflammatory state of the lower gastrointestinal tract (colon). The diagnosis requires diagnostic colonoscopy with characteristic histopathological findings. They have a propensity to present in senior populations (above 60 years of age), particularly women - who are approximately 2.5-3 times more likely to develop microscopic colitis. Preexisting other immune-inflammatory diseases are also shown to predispose patients for the development of microscopic colitis. The classic presentation is profuse watery diarrhea, often during the night or early morning hours. Fecal incontinence and abdominal pain are frequent as well. Thus, the disease impacts patients' quality of life and well-being. The first described cases date back to the seventies and eighties of the twentieth century, thereby they can be considered fairly recently discovered disease states. Our understanding of the disease and its pathophysiology is still incomplete. Although there is a lack of unified recommendation for treatment, most clinicians prefer the use of budesonide, and most published guidelines regard this locally acting glucocorticoid as the therapy of choice. In our article, we aimed for a brief, noncomprehensive overview of the clinical significance, diagnosis, and management of microscopic colitis.
Collapse
Affiliation(s)
- Istvan Fedor
- Department of Public Health and Epidemiology,
Faculty of Medicine, University of Debrecen, Kassai Street 26., Debrecen
4012, Hungary
- Department of Clinical Immunology, Doctoral
School of Clinical Immunology and Allergology, Institute of Internal
Medicine, Faculty of Medicine, University of Debrecen, Moricz Zs. Street
22., Debrecen 4004, Hungary
| | - Eva Zold
- Department of Clinical Immunology, Doctoral
School of Clinical Immunology and Allergology, Institute of Internal
Medicine, Faculty of Medicine, University of Debrecen, Debrecen,
Hungary
| | - Zsolt Barta
- GI Unit, Department of Infectology, Doctoral
School of Clinical Immunology and Allergology, Faculty of Medicine,
University of Debrecen, Debrecen, Hungary
| |
Collapse
|
|
5
|
No Microscope Needed: A Macroscopic Presentation of Collagenous Colitis. ACG Case Rep J 2021; 8:e00657. [PMID: 34476282 PMCID: PMC8397286 DOI: 10.14309/crj.0000000000000657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 03/31/2021] [Indexed: 12/02/2022] Open
Abstract
Microscopic colitis (MC) is a common cause of chronic secretory diarrhea with variable etiologies, including nonsteroidal anti-inflammatory drugs. As its name implies, the diagnosis requires consistent histopathologic findings that typically accompany normal-appearing mucosa. However, accumulating evidence suggests that the presence of distinct endoscopic features is associated with MC. We present a case of MC that highlights the importance of recognizing these macroscopic findings because they can aid in diagnosis and have significant management implications.
Collapse
|
|
6
|
McFarlane M, Disney B, Eaden J. Tears of colonoscopy. Gut 2018; 67:756. [PMID: 28232475 DOI: 10.1136/gutjnl-2017-313846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 02/05/2017] [Indexed: 12/08/2022]
Affiliation(s)
| | - Ben Disney
- Department of Gastroenterology, UHCW, Coventry, UK
| | - Jayne Eaden
- Department of Gastroenterology, UHCW, Coventry, UK
| |
Collapse
|
|
7
|
Marlicz W, Skonieczna-Żydecka K, Yung DE, Loniewski I, Koulaouzidis A. Endoscopic findings and colonic perforation in microscopic colitis: A systematic review. Dig Liver Dis 2017; 49:1073-1085. [PMID: 28847471 DOI: 10.1016/j.dld.2017.07.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 07/23/2017] [Accepted: 07/25/2017] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Microscopic colitis (MC) is a clinical syndrome of severe watery diarrhea with few or no endoscopic abnormalities. The incidence of MC is reported similar to that of other inflammatory bowel diseases. The need for histological confirmation of MC frequently guides reimbursement health policies. With the advent of high-definition (HD) coloscopes, the incidence of reporting distinct endoscopic findings in MC has risen. This has the potential to improve timely diagnosis and cost-effective MC management and diminish the workload and costs of busy modern endoscopy units. METHODS Publications on distinct endoscopic findings in MC available until March 31st, 2017 were searched systematically (electronic and manual) in PubMed database. The following search terms/descriptors were used: collagenous colitis (CC) OR lymphocytic colitis (LC) AND endoscopy, colonoscopy, findings, macroscopic, erythema, mucosa, vasculature, scars, lacerations, fractures. An additional search for MC AND perforation was made. RESULTS Eighty (n=80) articles, predominantly single case reports (n=49), were found. Overall, 1582 (1159F; 61.6±14.1 years) patients (pts) with MC and endoscopic findings were reported. The majority of articles (n=62) were on CC (pts 756; 77.5% females). We identified 16 papers comprising 779 pts (69.2% females) with LC and 7 articles describing 47 pts (72.3% females) diagnosed as MC. The youngest patient was 10 and the oldest a 97-year-old. Aside diarrhea, symptoms included abdominal pain, weight loss, bloating, flatulence, edema and others. In the study group we found 615 (38.8%) persons with macroscopic lesions in gut. Isolated linear ulcerations were identified in 7 pts (1.1%) while non-ulcerous lesions i.e. pseudomembranes, a variable degree of vasculature pruning & dwindling, mucosal lacerations and abnormalities such as erythema/edema/nodularity, or surface textural alteration in 608 pts (98.1%). The location of endoscopic findings was not reported in 27 articles. The distinct endoscopic findings were described in the left (descending, sigmoid, rectum - 10/21/11 studies), right (cecum, ascending - 7/7 studies), transverse colon (n=12), as well as duodenum (n=4), and terminal ileum (n=2). In 17 (1.1%) pts colonic perforation occurred. CONCLUSION Endoscopic findings are recognized with increased frequency in pts with MC. This could improve MC diagnosis by prompting a more extensive biopsy protocol in such cases and an earlier initiation of treatment. Procedure-related perforation has been reported in this group; therefore, cautious air insufflation is advisable when endoscopic findings are recognised.
Collapse
Affiliation(s)
- Wojciech Marlicz
- Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland.
| | | | - Diana E Yung
- Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Igor Loniewski
- Department of Biochemistry and Human Nutrition, Pomeranian Medical University, Szczecin, Poland; Sanprobi Sp. z o.o. Sp. K, Szczecin, Poland
| | | |
Collapse
|
|
8
|
Hui CK, Hui NK. Collagenous colitis presenting with skip lesions mimicking Crohn's disease and complicated by intestinal obstruction. J Dig Dis 2017; 18:487-491. [PMID: 28682012 DOI: 10.1111/1751-2980.12507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 05/09/2017] [Accepted: 07/03/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Chee K Hui
- Centre for Digestive Diseases, Kuala Lumpur, Malaysia
| | - Nyee Kit Hui
- Centre for Digestive Diseases, Kuala Lumpur, Malaysia
| |
Collapse
|
|
9
|
Koulaouzidis A, Yung DE, Nemeth A, Sjöberg K, Giannakou A, Qureshi R, Bartzis L, McNeill M, Johansson GW, Lucendo AJ, Fineron P, Trimble KC, Saeed A, Plevris JN, Toth E. Macroscopic findings in collagenous colitis: a multi-center, retrospective, observational cohort study. Ann Gastroenterol 2017; 30:309-314. [PMID: 28469361 PMCID: PMC5411381 DOI: 10.20524/aog.2017.0131] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 12/28/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Collagenous colitis (CC) is by definition a histological diagnosis. However, colonoscopy often reveals characteristic endoscopic findings. The aim of this study was to evaluate the frequency and type of endoscopic findings in patients diagnosed with CC in 4 participating centers. METHODS This was a retrospective study; the databases of 2 university hospitals in Edinburgh (Scotland) and Malmö (Sweden), and 2 district general hospitals in Tomelloso (Spain) and Gateshead (England) were interrogated for patients diagnosed with CC between May 2008 and August 2013. Endoscopy reports and images were retrieved and reviewed; data on lesions, sedation, bowel preparation and endoscopist experience were abstracted. Categorical data are reported as mean±SD. Fischer's exact, chi-square and t (unpaired) tests were used to compare datasets. A two-tailed P-value of <0.05 was considered statistically significant. RESULTS 607 patients (149 male, mean age 66.9±12.25 years) were diagnosed with CC. A total of 108/607 (17.8%) patients had one or more suggestive endoscopy findings: i.e., mucosal erythema/edema, 91/607 (15%); linear colonic mucosal defects, 12/607 (2%); or mucosal scarring, 5/607 (0.82%). For colonic mucosa erythema, there was no difference in the odds of finding erythema with the use of different bowel preparation methods (P=0.997). For colonic mucosal defects there was some evidence (P=0.005) that patients colonoscoped by experienced endoscopists had 87% less odds of developing such defects. Moreover, there was evidence that analgesia reduced the odds of developing mucosal defects by 84%. CONCLUSION A significant minority of patients with CC have endoscopic findings in colonoscopy. The description of such findings appears to be related to the endoscopist's experience.
Collapse
Affiliation(s)
- Anastasios Koulaouzidis
- Endoscopy Unit, The Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK (Anastasios Koulaouzidis, Diana E. Yung, Leonidas Bartzis, Ken C. Trimble, John N. Plevris)
| | - Diana E. Yung
- Endoscopy Unit, The Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK (Anastasios Koulaouzidis, Diana E. Yung, Leonidas Bartzis, Ken C. Trimble, John N. Plevris)
| | - Artur Nemeth
- Endoscopy Unit, Skåne University Hospital, Malmö, Sweden (Artur Nemeth, Gabriele Wurm Johansson, Ervin Toth)
| | - Klas Sjöberg
- Department of Gastroenterology and Nutrition, Skåne University Hospital, Lund University, Malmö, Sweden (Klas Sjöberg)
| | - Andry Giannakou
- Faculty of Economics & Management, Open University of Cyprus, Nicosia, Cyprus (Andry Giannakou)
| | - Raheel Qureshi
- Gastroenterology Department, Queen Elizabeth Hospital, Gateshead, England, UK (Raheel Qureshi, Athar Saeed)
| | - Leonidas Bartzis
- Endoscopy Unit, The Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK (Anastasios Koulaouzidis, Diana E. Yung, Leonidas Bartzis, Ken C. Trimble, John N. Plevris)
| | - Morna McNeill
- Department of Pathology, Western General Hospital, Edinburgh, Scotland, UK (Morna McNeill, Paul Fineron)
| | - Gabriele Wurm Johansson
- Endoscopy Unit, Skåne University Hospital, Malmö, Sweden (Artur Nemeth, Gabriele Wurm Johansson, Ervin Toth)
| | - Alfredo J. Lucendo
- Gastroenterology Department, Hospital General de Tomelloso, Spain (Alfredo J. Lucendo)
| | - Paul Fineron
- Department of Pathology, Western General Hospital, Edinburgh, Scotland, UK (Morna McNeill, Paul Fineron)
| | - Ken C. Trimble
- Endoscopy Unit, The Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK (Anastasios Koulaouzidis, Diana E. Yung, Leonidas Bartzis, Ken C. Trimble, John N. Plevris)
| | - Athar Saeed
- Gastroenterology Department, Queen Elizabeth Hospital, Gateshead, England, UK (Raheel Qureshi, Athar Saeed)
| | - John N. Plevris
- Endoscopy Unit, The Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK (Anastasios Koulaouzidis, Diana E. Yung, Leonidas Bartzis, Ken C. Trimble, John N. Plevris)
| | - Ervin Toth
- Endoscopy Unit, Skåne University Hospital, Malmö, Sweden (Artur Nemeth, Gabriele Wurm Johansson, Ervin Toth)
| |
Collapse
|
|
10
|
Mitchell A, Dugas A. Collagenous colitis presenting as spontaneous perforation in an 80 year old woman: Report of a Case. BMC Gastroenterol 2016; 16:124. [PMID: 27716080 PMCID: PMC5052946 DOI: 10.1186/s12876-016-0533-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 09/17/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Perforation of the colon occurring during or shortly following colonoscopy or barium enema is a rare complication of collagenous colitis (CC). "Spontaneous" perforation in CC, in which no instigating factor is identified, is even less common, with only five cases reported to date. We report herein an additional case of spontaneous perforation in previously undiagnosed CC and review the clinical and pathological features of previously reported cases. CASE PRESENTATION An 80 year old woman presented to the emergency department with abdominal pain preceded by approximately one month of frequent non-bloody diarrhea. Abdominal CT showed parietal thickening of the colon at the splenic flexure with pneumatosis and signs of perforation. Segmental resection was performed. Pathologic examination showed the microscopic findings typical of CC complicated by several deep ulcers and perforation. One day following discharge from hospital abdominal pain and frequent non-bloody diarrhea recurred. The patient was managed conservatively and treated with oral budesonide with resulting resolution of symptoms. CONCLUSIONS Spontaneous perforation is a rare and serious complication of CC. All patients to date have been female. In contrast to procedure-related perforation, which favors the right colon, spontaneous perforation in CC has in all cases involved the left colon. Knowledge of spontaneous perforation as a potential complication of previously undiagnosed CC may be helpful in the evaluation and management of patients presenting with colonic perforation, especially those with risk factors for CC.
Collapse
Affiliation(s)
- Andrew Mitchell
- Department of Anatomic Pathology and Cytology, Maisonneuve-Rosemont Hospital, 5415 Boulevard de L’Assomption, Montreal, Quebec H1T 2X1 Canada
| | - Alexandre Dugas
- Department of Radiology, Maisonneuve-Rosemont Hospital, 5415 Boulevard de L’Assomption, Montreal, Quebec H1T 2X1 Canada
| |
Collapse
|
|
11
|
Zabana Y, Ferrer C, Aceituno M, Salas A, Fernández-Bañares F. Advances for improved diagnosis of microscopic colitis in patients with chronic diarrhoea. GASTROENTEROLOGIA Y HEPATOLOGIA 2016; 40:107-116. [PMID: 26996466 DOI: 10.1016/j.gastrohep.2016.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 12/29/2015] [Accepted: 01/18/2016] [Indexed: 02/07/2023]
Abstract
Microscopic colitis is a generic term that includes 2 main forms, collagenous colitis and lymphocytic colitis, and describes a form of inflammatory bowel disease with a chronic and relapsing course. The incidence of microscopic colitis is between 2 and 8 times higher in women than in men, although age, more than sex, increases the risk of collagenous colitis (odds ratio [OR] 8.3 for age ≥65 vs. <65 and OR 2.8 for women). The main symptom is chronic non-bloody watery diarrhoea. Other common symptoms include abdominal pain (50%-70%), with the result that many patients with microscopic colitis meet criteria for irritable bowel syndrome. Colonoscopy with multiple colonic biopsies is currently recommended, as histological changes are the main characteristic feature. The colonic mucosa is macroscopically normal, although certain minimal endoscopic abnormalities have been described.
Collapse
Affiliation(s)
- Yamile Zabana
- Servicios de Digestivo, Hospital Universitari Mútua Terrassa, CIBERehd, Terrassa, Barcelona, España
| | - Carme Ferrer
- Anatomía Patológica, Hospital Universitari Mútua Terrassa, CIBERehd, Terrassa, Barcelona, España
| | - Montserrat Aceituno
- Servicios de Digestivo, Hospital Universitari Mútua Terrassa, CIBERehd, Terrassa, Barcelona, España
| | - Antonio Salas
- Anatomía Patológica, Hospital Universitari Mútua Terrassa, CIBERehd, Terrassa, Barcelona, España
| | | |
Collapse
|
|
12
|
Fernández-Bañares F, Casanova MJ, Arguedas Y, Beltrán B, Busquets D, Fernández JM, Fernández-Salazar L, García-Planella E, Guagnozzi D, Lucendo AJ, Manceñido N, Marín-Jiménez I, Montoro M, Piqueras M, Robles V, Ruiz-Cerulla A, Gisbert JP. Current concepts on microscopic colitis: evidence-based statements and recommendations of the Spanish Microscopic Colitis Group. Aliment Pharmacol Ther 2016; 43:400-26. [PMID: 26597122 DOI: 10.1111/apt.13477] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 10/01/2015] [Accepted: 10/23/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND Microscopic colitis (MC) is an underdiagnosed inflammatory bowel disease. AIM To develop an evidence-based clinical practice guide on MC current concepts. METHODS Literature search was done on the Cochrane Library, EMBASE and MEDLINE electronic databases, which were consulted covering the period up until March 2015. Work groups were selected for each of the reviewed topics, with the purpose of drafting the initial statements and recommendations. They subsequently underwent a voting process based on the Delphi method. Each statement/recommendation was accompanied by the result of the vote the level of evidence, and discussion of the corresponding evidence. The grade of recommendation (GR) using the GRADE approach was established for diagnosis and treatment recommendations. RESULTS Some key statements and recommendations are: advancing age increases the risk of developing MC, mainly in females. The symptoms of MC and IBS-D may be similar. If MC is suspected, colonoscopy taking biopsies is mandatory. Treatment with oral budesonide is recommended to induce clinical remission in patients with MC. Oral mesalazine is not recommended in patients with collagenous colitis for the induction of clinical remission. The use of anti-TNF-alpha drugs (infliximab, adalimumab) is recommended for the induction of remission in severe cases of MC that fail to respond to corticosteroids or immunomodulators, as an alternative to colectomy. CONCLUSIONS This is the first consensus paper on MC based on GRADE methodology. This initiative may help physicians involved in care of these patients in taking decisions based on evidence.
Collapse
Affiliation(s)
- F Fernández-Bañares
- Hospital Universitari Mutua Terrassa, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - M J Casanova
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | | | - B Beltrán
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
- Hospital La Fe, Valencia, Spain
| | - D Busquets
- Hospital Doctor Josep Trueta, Girona, Spain
| | - J M Fernández
- Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | | | | | | | - A J Lucendo
- Hospital General de Tomelloso, Ciudad Real, Spain
| | - N Manceñido
- Hospital Infanta Sofía, San Sebastián de los Reyes, Spain
| | - I Marín-Jiménez
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | - V Robles
- Hospital Vall d'Hebron, Barcelona, Spain
| | | | - J P Gisbert
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | | |
Collapse
|
|
13
|
Abstract
Lymphocytic colitis is a chronic inflammatory disease affecting the bowel. The clinical course of lymphocytic colitis is believed to be benign with watery diarrhoea. We report herein what is, to the best of our knowledge, the first case of lymphocytic colitis complicated by a terminal ileal mass. A 23-year-old man presented with diarrhoea. Blind biopsies of samples taken from the terminal ileum, caecum and ascending colon showed features of lymphocytic colitis. He declined treatment with budesonide or 5-aminosalicylates. He presented 14 months later with pain over the right lumbar region and nausea. Computed tomographic enteroclysis showed a focal soft tissue enhancing mass at the terminal ileum. Excision of the soft tissue mass revealed that it was reactive nodular lymphoid hyperplasia with fibrous granulation tissue. In conclusion, an untreated lymphocytic colitis may result in the formation of an inflammatory mass lesion.
Collapse
Affiliation(s)
- Chee-Kin Hui
- Centre For Alimentary Studies, Hong Kong SAR, China
- Quality Healthcare Medical Services, Hong Kong SAR, China
- Correspondence: Dr Hui Chee-Kin, Blk 207 Toa Payoh North, #03-1241, Singapore 310207.
| |
Collapse
|
|
14
|
Akamoto S, Fujiwara M, Okano K, Suzuki Y. Spontaneous perforation in collagenous colitis. Surgery 2014; 155:198-9. [PMID: 23218876 DOI: 10.1016/j.surg.2012.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Accepted: 10/22/2012] [Indexed: 10/27/2022]
Affiliation(s)
- Shintaro Akamoto
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan.
| | - Masao Fujiwara
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Keiichi Okano
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Yasuyuki Suzuki
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan
| |
Collapse
|
|
15
|
Koulaouzidis A, Saeed AA. Distinct colonoscopy findings of microscopic colitis: Not so microscopic after all? World J Gastroenterol 2011; 17:4157-65. [PMID: 22072846 PMCID: PMC3209563 DOI: 10.3748/wjg.v17.i37.4157] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Revised: 05/20/2011] [Accepted: 05/27/2011] [Indexed: 02/06/2023] Open
Abstract
Microscopic colitis (MC) is considered an “umbrella term”, comprising two subtypes, i.e., collagenous colitis (CC) and lymphocytic colitis (LC). They are classically associated with normal or unremarkable colonoscopy. In the last few years, reports have been published revealing findings that are thought to be characteristic or pathognomonic of MC, especially CC. A systematic electronic and manual search of PubMed and EMBASE (to December 2010), for publications on distinct endoscopic findings in MC, resulted in 42 relevant reports for inclusion in this review. Eighty eight patients with collagenous colitis were presented. Only one publication describing a distinct endoscopic pattern in LC was found. Typical findings in CC are alteration of the vascular mucosal pattern, mucosal nodularity, a sequence of change from mucosal defects to mucosal cicatricial lesions, and perhaps (although of doubtful relevance) mucosal pseudomembranes. A causal connection of mucosal defects with the use of lansoprazole seems to exist. Adoption of the proposed lesion description herein is recommended in order to improve homogeneity of future reports.
Collapse
|