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van Hemert S, Skonieczna-Żydecka K, Loniewski I, Szredzki P, Marlicz W. Microscopic colitis-microbiome, barrier function and associated diseases. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:39. [PMID: 29610731 DOI: 10.21037/atm.2017.03.83] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Microscopic colitis (MC) is a chronic inflammatory bowel disease (IBD) with little in terms of endoscopic abnormalities and is frequently associated with other autoimmune diseases. The peak incidence of the disease is in middle aged or older populations, mostly females. The pathogenesis of MC is complex, multifactorial and poorly understood. Current concepts revolve around innate immunity or microbiome alterations as well as gut barrier dysfunction, all of which lead to the development of subtle inflammatory lesions in gut mucosa. The results of numerous basic and clinical studies involving molecular techniques as well as advanced endoscopic imaging revealed the important role of both intrinsic (e.g., hormonal) as well as extrinsic (e.g., NSAIDs and PPIs) factors in the modulation of gastrointestinal microbiome and MC pathogenesis. Capsule endoscopy as well confocal endomicroscopy imaging, alongside standard endoscopic techniques offer new tools in the evaluation of MC patients and allow their better stratification for novel treatment protocols based on modulation of gut microbiome and barrier function.
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Affiliation(s)
| | | | - Igor Loniewski
- Department of Biochemistry and Human Nutrition, Pomeranian Medical University, Szczecin, Poland.,Sanprobi Sp. z o.o. Sp. K., Szczecin, Poland
| | - Piotr Szredzki
- Endoscopy Unit, Department of Surgery, Hospital Sędziszów Małopolski, Sędziszów Małopolski, Poland
| | - Wojciech Marlicz
- Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland
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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.
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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)
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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.
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