Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pathophysiol. Nov 15, 2016; 7(4): 307-313
Published online Nov 15, 2016. doi: 10.4291/wjgp.v7.i4.307
Microscopic colitis in patients with mild duodenal damage: A new clinical and pathological entity (“lymphocytic enterocolitis”)?
Gabriele Antonio Bonagura, Davide Giuseppe Ribaldone, Sharmila Fagoonee, Nicoletta Sapone, Gian Paolo Caviglia, Giorgio Maria Saracco, Marco Astegiano, Rinaldo Pellicano
Gabriele Antonio Bonagura, Davide Giuseppe Ribaldone, Nicoletta Sapone, Giorgio Maria Saracco, Marco Astegiano, Rinaldo Pellicano, Unit of Gastroenterology and Hepatology, Molinette Hospital, 10126 Torino, Italy
Sharmila Fagoonee, Institute for Biostructures and Bioimages-CNR c/o Molecular Biotechnology Center, University of Torino, 10126 Turin, Italy
Gian Paolo Caviglia, Department of Medical Sciences, University of Turin, 10123 Turin, Italy
Giorgio Maria Saracco, Department of Oncology, University of Torino, 10126 Torino, Italy
Author contributions: Bonagura GA and Ribaldone DG equally contributed to this paper; Bonagura GA, Ribaldone DG, Saracco GM, Astegiano M and Pellicano R designed the research; Bonagura GA, Ribaldone DG, Fagoonee S and Sapone N performed the research; Fagoonee S and Caviglia GP analyzed the data; Bonagura GA, Ribaldone DG, Astegiano M and Pellicano R wrote the paper.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Molinette Hospital.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous data and it was performed several years after the consultation (retrospective).
Conflict-of-interest statement: None to declare.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Davide Giuseppe Ribaldone, MD, Unit of Gastroenterology and Hepatology, Molinette Hospital, S.G.A.S., Via Cavour 31, 10126 Torino, Italy. davrib_1998@yahoo.com
Telephone: +39-01-16335208 Fax: +39-01-16336752
Received: June 22, 2016
Peer-review started: June 22, 2016
First decision: September 1, 2016
Revised: September 3, 2016
Accepted: September 21, 2016
Article in press: September 22, 2016
Published online: November 15, 2016
Processing time: 144 Days and 13 Hours
Abstract
AIM

To evaluate the potential association between mild duodenal damage and microscopic colitis (MC).

METHODS

We retrospectively included 105 consecutive patients with type I Marsh-Oberhuber duodenal damage and negativity for immunoglobulin A anti-endomysium and anti-tissue transglutaminase. The following parameters were analyzed: Sex, age at execution of esophagogastroduodenoscopy, duodenal damage, and number of intraepithelial lymphocytes at biopsies, prevalence of Helicobacter pylori infection, age at execution of colonoscopy, macroscopic and microscopic features of colonoscopy, family history of gastrointestinal and autoimmune diseases, smoking habits, biochemical parameters of inflammation and autoimmunity, use of proton pump inhibitors or nonsteroidal anti-inflammatory drugs, adverse reactions to drugs or foods, pathologies known to be associated with celiac disease or MC, living on a gluten-free diet or on a gluten-low diet for at least 1 mo.

RESULTS

Colonoscopy was performed in 59 patients, but only in 48 of them biopsies were taken in the entire colon. Considering the latter cohort, the diagnosis of MC was met in 25 (52.1%) patients while in 18 patients other pathologic findings were reported: 13 (27%) cases of nonspecific inflammatory bowel disease, 2 (4.2%) cases of Crohn’s disease, 2 (4.2%) cases of eosinophilic gastroenteritis, and 1 (2.1%) case of autoimmune enteritis. Five (10.4%) patients had a normal colonoscopic result. Matching the groups by age, and considering only patients who underwent colonoscopy (42.7 ± 15.5 years) vs those who did not undergo colonoscopy (36.9 ± 10.6 years), a statistical difference was found (P = 0.039). Focusing on symptoms, diarrhea was statistically more prevalent in MC group than in patients who did not undergo colonoscopy (P = 0.03).

CONCLUSION

Mild duodenal damage is associated with MC in more than half of the cases. This association supports the hypothesis of a link between these two entities.

Keywords: Autoimmune diseases; Celiac disease; Helicobacter pylori; Intraepithelial lymphocytes; Lymphocytic colitis; Lymphocytic enterocolitis; Microscopic colitis

Core tip: Scarce information is available on patients with symptoms suggestive for celiac disease but with negative serologic tests and mild duodenal damage (type I Marsh-Oberhuber classification). Our data show that mild duodenal damage is associated with microscopic colitis in more than the half of the investigated cases. This association may support the hypothesis of a new clinical and pathological entity, the “lymphocytic enterocolitis”.