scholarly journals Long-Term Natural History and Complications of Collagenous Colitis

2012 ◽  
Vol 26 (9) ◽  
pp. 627-630 ◽  
Author(s):  
Hugh J Freeman
Keyword(s):  
Clinical Course ◽  
Collagenous Colitis ◽  
Lymphoproliferative Disease ◽  
Inflammatory Bowel ◽  
Inflammatory Drugs ◽  
Colonic Ulceration ◽  
Neoplastic Disorders ◽  
Small Intestinal ◽  
Air Insufflation

Microscopic forms of colitis have been described, including collagenous colitis, a possibly heterogeneous disorder. Collagenous colitis most often appears to have an entirely benign clinical course that usually responds to limited treatment. Sometimes significant extracolonic disorders, especially arthritis, spondylitis, thyroiditis and skin disorders, such as pyoderma gangrenosum, dominate the clinical course and influence the treatment strategy. However, rare fatalities have been reported and several complications, some severe, have been attributed directly to the colitis. Toxic colitis and toxic megacolon may develop. Concomitant gastric and small intestinal inflammatory disorders have been described including celiac disease and more extensive collagenous inflammatory disease. Colonic ulceration has been associated with the use of nonsteroidal anti-inflammatory drugs, while other forms of inflammatory bowel disease, including ulcerative colitis and Crohn disease, may evolve directly from collagenous colitis. Submucosal ‘dissection’, colonic fractures, or mucosal tears and perforation, possibly from air insufflation during colonoscopy, have been reported. Similar changes may result from increased intraluminal pressures that may occur during radiological imaging of the colon. Neoplastic disorders of the colon may also occur during the course of collagenous colitis, including colon carcinoma and neuroendocrine tumours (ie, carcinoids). Finally, lymphoproliferative disease has been reported.

Long-Term Follow up of Patients with Cold Agglutinin Disease.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 3710-3710 ◽  
Author(s):  
Ronald S. Go ◽  
Stephanie L. Serck ◽  
Jeffrey J. Davis ◽  
Wayne A. Bottner ◽  
Craig E. Cole ◽  
...  
Keyword(s):  
Clinical Course ◽  
Lymphoproliferative Disease ◽  
Cold Agglutinin ◽  
Low Grade ◽  
Lymphoproliferative Diseases ◽  
Cold Agglutinin Disease ◽  
Lymphoid Malignancies ◽  
Long Term Follow Up

Abstract Background: Data regarding long-term follow up of patients (pts) with cold agglutinin disease (CAD) are limited. Methods: We reviewed our institutional database of pts with CAD from 1981–2003. The diagnosis of CAD was confirmed by the following criteria: hemolysis and/or cold induced agglutination symptoms, cold agglutinin titre of ≥ 1:40, and typical direct anti-globulin test findings. We retrospectively collected pertinent clinical data including: demographics, dates of diagnosis and last follow up, associated hematologic diseases, baseline laboratory test results, treatment, clinical course, and subsequent development of lymphoproliferative diseases. Results: We identified 18 pts with CAD. Most (15) were females. The median age at diagnosis was 71.5 years (range, 22–92). While all pts presented with hemolysis, only 2 had cold-induced acral signs or symptoms. The median presenting hemoglobin level was 8.4 gm/dl (range, 4.5–13.5). The cause was considered idiopathic in 10 pts, while 8 pts had concomitant lymphoproliferative disorders at diagnosis: chronic lymphocytic leukemia, 1 pt; non-Hodgkin lymphoma (NHL), 3 pts; and monoclonal gammopathy of undetermined significance (MGUS), 5 pts. A serum protein electrophoresis was obtained in 16 pts. Five pts had monoclonal proteins, all IgM (3 κ, 2 λ). Thirteen (72%) pts required treatment for CAD or associated lymphoid malignancies at some point in the course of their disease. The most common treatments administered for CAD were prednisone (9 pts) and cyclophosphamide (3 pts). Prednisone produced an overall response rate of 78%. The responses were durable with a median of 95 months (range, 15–414). No one responded to cyclophosphamide. After a median follow up of 55.5 months (mean, 99.5; range, 12–449), 8 pts were alive, 5 in complete remission (2 maintained on prednisone), and 3 in partial remission (all off therapy). Of those who died (10 pts), only 1 died of CAD due to complications from severe anemia. Two pts subsequently developed lymphoproliferative diseases, MGUS (IgMk) and low grade NHL, 125 and 175 months after diagnosis, respectively. The clinical course of CAD did not seem to be any worse in pts with lymphoid malignancies. Conclusions: In our series, pts with CAD are frequently associated (44%) with lymphoproliferative disease at diagnosis. They have a relatively benign clinical course with a good likelihood of long-term disease remission. Unlike previous reports, prednisone is quite effective. Among those pts considered to have idiopathic CAD, a lymphoproliferative disease may develop later during the course of their disease.

scholarly journals Sa1854 – Impact of Bariatric Surgery on the Long-Term Clinical Course of Inflammatory Bowel Diseases

2019 ◽  
Vol 156 (6) ◽  
pp. S-429
Author(s):  
Manuel Bonfim Braga Neto ◽  
Martin H. Gregory ◽  
Guilherme Piovezani Ramos ◽  
David H. Bruining ◽  
Fateh Bazerbachi ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Inflammatory Bowel Diseases ◽  
Clinical Course ◽  
Bowel Diseases ◽  
Inflammatory Bowel

Microscopic Colitis

2015 ◽  
Vol 33 (2) ◽  
pp. 208-214 ◽  
Author(s):  
Gerd Bouma ◽  
Andreas Münch
Keyword(s):  
Randomized Clinical Trials ◽  
Collagenous Colitis ◽  
Intraepithelial Lymphocytes ◽  
Microscopic Colitis ◽  
Common Denominator ◽  
Proven Efficacy ◽  
Inflammatory Bowel ◽  
Long Term Prognosis ◽  
Maintenance Of Remission

Microscopic colitis (MC) is the common denominator for lymphocytic and collagenous colitis (CC). It is now recognized as a relatively frequent cause of diarrhea that equals the prevalence of inflammatory bowel disease. Patients are typically middle-aged women, but disease may occur at every age. Patients with MC report watery, non-bloody diarrhea in the absence of endoscopic and radiologic abnormalities. Lymphocytic colitis is characterized by an increased number of intraepithelial lymphocytes, and CC by a thickened subepithelial collagen band, whereas in both an increased mononuclear infiltration of the lamina propria is found. The pathogenesis of MC is largely unknown, but may relate to autoimmunity, adverse reactions to drugs or (bacterial) toxins, and abnormal collagen metabolism in the case of CC. Budesonide is so far the only drug that has proven efficacy in randomized controlled trials both for the induction and maintenance of remission. Patients who are nonresponsive, dependent or who experience side effects on budesonide may benefit from thiopurine or anti-TNF treatment, but these options are still experimental. The long-term prognosis of MC is good; it does not appear to predispose to malignancies and can in some cases be self-limiting. Further research and randomized clinical trials are required to expand our understanding of the natural course and the pathogenesis of MC.

scholarly journals Spontaneous Peritonitis from Perforation of the Colon in Collagenous Colitis

2001 ◽  
Vol 15 (4) ◽  
pp. 265-267 ◽  
Author(s):  
HJ Freeman ◽  
D James ◽  
CJ Mahoney
Keyword(s):  
Inflammatory Bowel Disease ◽  
Sigmoid Colon ◽  
Bowel Disease ◽  
Clinical Course ◽  
Collagenous Colitis ◽  
Watery Diarrhea ◽  
Colon Perforation ◽  
Life Threatening ◽  
Inflammatory Bowel ◽  
Sigmoid Colon Perforation

A 37-year-old woman presented with an acute abdomen following the onset of watery diarrhea. Spontaneous peritonitis was detected, along with evidence of a focal sigmoid colon perforation. Subsequent postoperative colonoscopic studies revealed collagenous colitis with a focal, deep, nongranulomatous ulcer in the sigmoid colon. Although the literature suggests that collagenous colitis tends to have a relatively 'benign' clinical course characterized by chronic or episodic watery diarrhea. Potentially serious and life- threatening complications may occur in this microscopic form of inflammatory bowel disease.

Mo1128 INFLUENCE OF NUDT15 AND TPMT ON LONG-TERM CLINICAL COURSE OF PATIENTS WITH INFLAMMATORY BOWEL DESEASE TREATED WITH THIOPURINES

2020 ◽  
Vol 158 (6) ◽  
pp. S-797-S-798
Author(s):  
Yuichiro Kojima ◽  
Yosuke Hirotsu ◽  
Shotaro Tsunoda ◽  
Hiryoyuki Amano ◽  
Yuko Miura ◽  
...  
Keyword(s):  
Clinical Course ◽  
Inflammatory Bowel

Novel Targets For Therapeutic Intervention in Inflammatory Bowel Disease. What is the Best Way to Assess the Safety Profile of a Drug?

2019 ◽  
Vol 25 (1) ◽  
pp. 57-63 ◽  
Author(s):  
Clara Yzet ◽  
Stacy S. Tse ◽  
Maia Kayal ◽  
Robert Hirten ◽  
Jean-Frédéric Colombel
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Evaluation Process ◽  
Population Based ◽  
Stage Of Development ◽  
Remission Rates ◽  
Safety Parameters ◽  
Post Marketing ◽  
Inflammatory Bowel

The emergence of biologic therapies has revolutionized the management of inflammatory bowel disease (IBD) by halting disease progression, increasing remission rates and improving long-term clinical outcomes. Despite these well-described benefits, many patients are reluctant to commence therapy due to drug safety concerns. Adverse events can be detected at each stage of drug development and during the post-marketing period. In this article, we review how to best assess the safety parameters of new IBD medications, from the earliest stage of development to population-based registries, with a focus on the special populations often excluded from the evaluation process.

Corticosteroids in Inflammatory Bowel Disease patients: a practical guide for physicians.

2020 ◽  
Vol 15 ◽  
Author(s):  
Maria Carla Di Paolo ◽  
Cristiano Pagnini ◽  
Maria Giovanna Graziani
Keyword(s):  
Severe Disease ◽  
Unknown Etiology ◽  
History Of Disease ◽  
Bowel Diseases ◽  
Literature Evidence ◽  
History Of ◽  
Inflammatory Bowel ◽  
Favorable Safety ◽  
Pass Metabolism

: Inflammatory bowel diseases (IBDs) are chronic conditions characterized by unknown etiology and pathogenesis with deregulation of mucosal immunity. Among possible treatments, corticosteroids, already available from the 50’, are still the mainstay of treatment for moderate-severe disease. Nonetheless, the use of steroids is still largely empirical and solid evidence about therapeutic schemes are lacking. Moreover, due to the important side-effects and for the unsatisfactory impact on long-term natural history of disease, the steroid sparing has become an important therapeutic goal in IBD management. Besides conventional steroids, the so called “low bioavailability” steroids, which are steroids with high affinity for peripheral receptors and elevated hepatic first-pass metabolism, have demonstrated efficacy and more favorable safety profile. In the present review of the literature evidence of efficacy and safety of conventional and low bioavailability steroids in IBD patients are evaluated, and practical suggestions for a correct use in clinical practice are presented according to the current clinical guidelines.

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