Microscopic Colitis

2015 ◽  
Author(s):  
Anthony O’Connor ◽  
Alan C. Moss
Keyword(s):  
Differential Diagnosis ◽  
Colonic Mucosa ◽  
Collagenous Colitis ◽  
Evidence Base ◽  
Intraepithelial Lymphocytes ◽  
Microscopic Colitis ◽  
Lymphocytic Colitis ◽  
Colonic Epithelium ◽  
Treatment Complications

Microscopic colitis (MC) is defined by the presence of specific histologic abnormalities in patients with diarrhea and a normal-appearing colon at endoscopy. MC can be categorized into two types: collagenous colitis (CC) and lymphocytic colitis (LC). CC is characterized by a thickened subepithelial collagen band in the colonic mucosa of at least 10 mm in thickness, whereas LC describes infiltration of the colonic epithelium with lymphocytes (intraepithelial lymphocytes), without excess collagen in the mucosa. This review of MC addresses the epidemiology, pathogenesis, etiology/genetics, diagnosis, differential diagnosis, treatment, complications, and prognosis between the two types. Tables list potential etiologic factors in MC, medications associated with MC, and treatments used for MC and evidence base. This review contains 3 tables and 55 references.

scholarly journals Familial Microscopic Colitis

2001 ◽  
Vol 15 (5) ◽  
pp. 341-343 ◽  
Author(s):  
Ayman Assad Abdo ◽  
Peter Jeffrey Zetler ◽  
Lawrence S Halparin
Keyword(s):  
Chronic Diarrhea ◽  
Present Report ◽  
Disease Process ◽  
Collagenous Colitis ◽  
Microscopic Colitis ◽  
Familial Occurrence ◽  
Lymphocytic Colitis ◽  
The Third ◽  
Inflammatory Conditions ◽  
Colonic Biopsy

Collagenous and lymphocytic colitis are two inflammatory conditions of the colon that are often collectively referred to as microscopic colitis. The present report describes what is believed to be the third published case of familial microscopic colitis. A 55-year-old woman who suffered from chronic diarrhea was diagnosed with lymphocytic colitis on colonic biopsy. Subsequently, her 36-year-old daughter was diagnosed with collagenous colitis. The familial occurrence of these diseases may support an immunological hypothesis for their etiology. In addition, it supports the assumption that collagenous and lymphocytic colitis are two manifestations of the same disease process rather than two completely separate entities. The familial tendency of this disease may make a case for early colonoscopy and biopsy in relatives of patients diagnosed with microscopic colitis if they present with suggestive symptoms.

scholarly journals Lymphocytic colitis: clinical presentation and long term course

Gut ◽  
1998 ◽  
Vol 43 (5) ◽  
pp. 629-633 ◽  
Author(s):  
B Mullhaupt ◽  
U Güller ◽  
M Anabitarte ◽  
R Güller ◽  
M Fried
Keyword(s):  
Colonic Mucosa ◽  
Clinical Presentation ◽  
Collagenous Colitis ◽  
Endoscopic Examination ◽  
Watery Diarrhoea ◽  
Lymphocytic Colitis ◽  
Radiological Findings ◽  
Benign Course

Background—Lymphocytic colitis is characterised by chronic watery diarrhoea with normal endoscopic or radiological findings and microscopic evidence of pronounced infiltration of the colonic mucosa with lymphocytes.Aim—To investigate the long term clinical and histological evolution of the disease in a large group of patients with well characterised lymphocytic colitis.Methods—Between 1986 and 1995 the histological diagnosis of lymphocytic colitis was obtained in 35 patients; 27 of these agreed to a follow up examination. All clinical, endoscopic, and histopathological records were reviewed at that time and the patients had a second endoscopic examination with follow up biopsies.Results—The patients initially presented with the typical findings of lymphocytic colitis. After a mean (SD) follow up of 37.8 (27.5) months, diarrhoea subsided in 25 (93%) and histological normalisation was observed in 22 (82%) of the 27 patients. Progression from lymphocytic colitis to collagenous colitis was not observed.Conclusions—Lymphocytic colitis is characterised by a benign course with resolution of diarrhoea and normalisation of histology in over 80% of patients within 38 months. Considering the benign course of the disease, the potential benefit of any drug treatment should be carefully weighed against its potential side effects.

scholarly journals Microscopic Colitis: Epidemiology, Pathophysiology, Diagnosis and Current Management—An Update 2013

2013 ◽  
Vol 2013 ◽  
pp. 1-12 ◽  
Author(s):  
Martin Alexander Storr
Keyword(s):  
Colonic Mucosa ◽  
Chronic Diarrhea ◽  
Treatment Options ◽  
Correct Diagnosis ◽  
Collagenous Colitis ◽  
Microscopic Colitis ◽  
Normal Colonic Mucosa ◽  
Clinical Value ◽  
Current Management ◽  
And Gender

Microscopic colitis is a common cause of chronic diarrhea. Over the last years the incidence and the prevalence of microscopic colitis are rising and this rise is largely attributed to a rising awareness, and concomitantly an increasing number of diagnoses are made. Patients with microscopic colitis report watery, nonbloody diarrhea of chronic, intermittent, or chronic recurrent course. Following an unremarkable physical examination the diagnosis of microscopic colitis is made by colonoscopy, which shows essentially a normal colonic mucosa. Biopsies taken during the colonoscopy procedure will then finally establish the correct diagnosis. Histological workup can then confirm a diagnosis of microscopic colitis and can distinguish the two distinct histological forms, namely, collagenous colitis and lymphocytic colitis. Presently both forms are diagnosed and treated in the same way; thus the description of the two forms is not of clinical value, though this may change in future. Depending on the patients age and gender 10–30% of patients investigated for chronic diarrhea will be diagnosed with microscopic colitis if biopsies are taken. Microscopic colitis is most common in older patients, especially in female patients and is frequently associated with autoimmune disorders and the consumption of several drugs. This review summarizes the present knowledge of the epidemiology, the pathophysiology, and the diagnosis of microscopic colitis and discusses the former and the present treatment options.

Evaluation of the Extrapineal Sources of Melatonin in Patients with Lymphocytic Colitis

2017 ◽  
Vol 6 (04) ◽  
Author(s):  
Cezary Chojnacki ◽  
Janusz Błasiak ◽  
Jakub Fichna ◽  
Jan Chojnacki ◽  
Tomasz Popławski ◽  
...  
Keyword(s):  
Monoclonal Antibodies ◽  
Healthy Subjects ◽  
Chromogranin A ◽  
Colonic Mucosa ◽  
Intraepithelial Lymphocytes ◽  
Urine Concentration ◽  
Enterochromaffin Cells ◽  
Lymphocytic Colitis ◽  
Photometric Method ◽  
Rt Pcr

Melatonin can be synthesized by different cells in the gastrointestinal tract. The aim of this study was to evaluate the expression of melatonin-synthesizing enzymes: arylalkylamine-N-acetyltransferase(AANAT) and N-acetylserotonin methyltransferase (ASMT) in colonic mucosa and urinary 6-sulfatoxymelatonin excretion(aMT6s) in patients with lymphocytic colitis(LC) related to the number of intraepithelial lymphocytes(IEL) and enterochromaffin cells (EC). The study included 32 healthy subjects (HS group) and 36 patients with lymphocytic colitis (LC group). The diagnosis was based on histological and immunohistochemical performances using mouse monoclonal antibodies (chromogranin A –LK 2H10). EC were counted in 10 fields of each bioptate at 40x magnification. The level of mRNA expression of AANAT and ASMT was estimated in colonic mucosa with RT-PCR. The urine concentration of aMT6s was determined by photometric method. Significant differences were found in obtained results between HS and LC group: the number of IEL 14.1±3.41 vs. 32.4±5.50 per 100 surface colonocytes (p less than 0.001); the number of EC 32.2±10.1 vs. 70.4±21.2 (p less than 0.001); AANAT -1.32±0.47 vs. 2.32±0.65 (pless than 0.001; ASMT – 1.51±0.59 vs. 2.80±0.92 (p less than 0.001) aMT6s- 13.4±4.87 vs. 19.9±6.29 (p less than 0.001). Moreover, a positive correlation was found between the number of EC and ASMT (p= 0.011) and between EC and aMT6s (p less than 0.001). No correlation occurred between the number of IEL and AANAT p=0.932) and AMST (n=0.536) and aMT6s (p=9.288). These results indicate that the enterochromaffin cells in colonic mucosa are the main extrapineal source of melatonin in patients with lymphocytic colitis.

scholarly journals A196 MORE MICROSCOPIC THAN WAS THOUGHT: A RARE CASE OF ISOLATED LYMPHOCYTIC ILEITIS WITHOUT MICROSCOPIC COLITIS

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 219-220
Author(s):  
K S Singh ◽  
R Yanofsky ◽  
D Haegert ◽  
Z Gao ◽  
T Bessissow
Keyword(s):  
Terminal Ileum ◽  
Oral Intake ◽  
Collagenous Colitis ◽  
Lymphocytic Infiltration ◽  
Chronic Inflammatory Disease ◽  
Microscopic Colitis ◽  
Lymphocytic Colitis ◽  
Colonic Disease ◽  
Normal Colonic Mucosa ◽  
Macroscopic Appearance

Abstract Background Microscopic colitis (MC) is a chronic inflammatory disease of the colon characterized by lymphocytic infiltration with (collagenous colitis) or without (lymphocytic colitis) the expansion of collagen fibres, and the normal macroscopic appearance of the mucosa on ileocolonoscopy. Recent studies have shown that the ileum may be involved in MC, occurring concurrently with colonic disease, however there is sparse literature on isolated lymphocytic ileitis without colitis. Aims We describe the case of isolated small bowel lymphocytosis without evidence of lymphocytic colitis to highlight the utility of random biopsies of the terminal ileum in cases where microscopic colitis is a diagnostic consideration. Methods A 70-year-old female known for cutaneous mastocytosis presented with six weeks of abdominal pain, non-bloody diarrhea, intolerance to oral intake and significant weight loss. Computed-tomography showed evidence of possible mesenteric panniculitis. Colonoscopy revealed a normal colon and normal-appearing mucosa of the terminal ileum. Random mucosal biopsies were taken to assess for microscopic colitis, with terminal ileal biopsies revealing significant lymphocytic infiltration consistent with lymphocytic ileitis. Biopsies throughout the colon revealed normal colonic mucosa without evidence of concurrent microscopic colitis. Gastroscopy was macroscopically unremarkable and random biopsies in the stomach and duodenum were negative for Helicobacter pylori and lymphocytosis. Immunostaining of the gastric, duodenal, terminal ileal and colonic biopsy specimens were negative for CD25, CD117 and tryptase, indicating the absence of gastrointestinal mastocytosis. Results The patient was diagnosed with lymphocytic ileitis and given the known response of MC to budesonide, she was treated with eight weeks of budesonide with clinical improvement leading to remission of her symptoms. Conclusions This case illustrates a rare incidence of isolated ileal microscopic ileitis without colitis that responded well to standard MC treatment, thereby underscoring the utility of random biopsies in the terminal ileum and throughout the colon when microscopic colitis is on the differential diagnosis. Funding Agencies None

scholarly journals Microscopic Colitis with Macroscopic Endoscopic Findings

2013 ◽  
Vol 2013 ◽  
pp. 1-2 ◽  
Author(s):  
Atif Saleem ◽  
Parag A. Brahmbhatt ◽  
Sarah Khan ◽  
Mark Young ◽  
Gene D. LeSage
Keyword(s):  
White Light ◽  
Colonic Mucosa ◽  
Collagenous Colitis ◽  
Microscopic Colitis ◽  
Watery Diarrhea ◽  
White Light Endoscopy ◽  
Endoscopic Findings ◽  
Microscopic Inflammation

Microscopic Colitis (MC) is characterized by chronic watery diarrhea, grossly normal appearing colonic mucosa during conventional white light endoscopy, and biopsy showing microscopic inflammation. We report a case of collagenous colitis with gross endoscopic findings.

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 Microscopic Colitis- Its Prevalence and Characteristics in Diarrhoea Predominant Irritable Bowel Syndrome- A Study of 100 Cases

2016 ◽  
Vol 12 (1) ◽  
pp. 57-62
Author(s):  
SM Mizanur Rahman ◽  
SM Motahar Hossain ◽  
Niamul Gani Chowdhury ◽  
Md Delwar Hossain ◽  
Jakeya Rashid
Keyword(s):  
Irritable Bowel Syndrome ◽  
Collagenous Colitis ◽  
Microscopic Colitis ◽  
Lymphocytic Colitis ◽  
Military Hospital ◽  
Elderly Persons ◽  
Rome Iii Criteria ◽  
Chronic Inflammatory Condition ◽  
Rome Iii ◽  
Irritable Bowel

Introduction: Irritable bowel Syndrome (IBS) is a functional disorder of abdominal pain or discomfort associated with altered bowel habit. Microscopic colitis is a chronic inflammatory condition associated with non bloody diarrhoea and characteristic histological finding. The subset of diarrhoea predominant IBS is having similarity in presentation with microscopic colitis. Objective: To assess the prevalence and characteristics of microscopic colitis in Diarrhoea predominant Irritable Bowel Syndrome (IBS-D). Materials and Methods: This observational study was conducted at the department of Gastroenterology, Combined Military Hospital, Dhaka during the period of January 2011 to June 2011. Initially 100 cases of diarrhoea predominant IBS who met Rome III criteria were included. Among those 100 cases, 57 were male and 43 were female. Mean age was 46 years ±2.8 SD(range 18-72). Six patients were subsequently excluded because of some macroscopic abnormalities at colonoscopy. Finally 94 patients of clinical IBS-D whose colonoscopy were normal, biopsy specimens were taken from caecum, transverse colon, descending colon, sigmoid and rectum. Microscopic colitis was diagnosed on the basis of evidence of increased intraepithelial lymphocytes of ≥20/100 inter cryptal epithelial cells and infiltration of lamina propria by mixed inflammatory cells. Overlap of other symptoms between Microscopic Colitis (MC) and IBS-D were also evaluated. Results: Among the 94 patients of clinical IBS-D, 23(24%) patients were histologically proved to have microscopic colitis. Besides Rome III criteria, there was significant overlap of other symptoms. Occasional fever and infrequent arthralgia 7% and 26% vs 4% respectively) but tenesmus, passage of excessive mucus and heart- burn were more prevalent in IBS-D than MC (35% vs 13%, 32% vs 4% and 32 vs 9% respectively). Among the 23 cases of MC, 13(57%) patients were female and 10(43%) patients were male. Mean age of microscopic colitis was 56 years ±2.6 SD (range 25-72). Regarding subtypes of microscopic colitis, 21(91%) patients had lymphocytic colitis (LC) and 2 (9%) patients had collagenous colitis (CC). Of the lymphocytic colitis 11 were female and 10 were male and of the 02 cases of collagenous colitis all were female. MC affected mostly the transverse colonie 11(48%) cases and the next common site was caecum ie 8(35%) cases. Conclusion: A good percentage of diarrhoea predominant IBS are actually having microscopic colitis. MC is more common in female and elderly persons. In all elderly patients of IBS-D full colonoscopy should be done and biopsy should be taken from multiple sites to exclude microscopic colitis. Journal of Armed Forces Medical College Bangladesh Vol.12(1) 2016: 57-62

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