Collagenous and Lymphocytic Colitis: Systematic Review and Update of the Literature

Abstract

Collagenous and lymphocytic colitis are well-described conditions causing chronic watery diarrhoea. A peak incidence from 60 to 70 years of age with a female predominance mainly in collagenous colitis is observed. Both conditions are characterised by a (near) normal colonoscopy, but with specific histologic findings on colonic biopsies. Histopathologically, both conditions are characterised by distinct epithelial abnormalities and a dense lymphoplasmocytic infiltrate. Distinct features consist of a characteristic collagen band deposition in the subepithelial layer in collagenous colitis and a markedly increased number of intra-epithelial lymphocytes in lymphocytic colitis. Although most cases are idiopathic, certain drugs can induce microscopic colitis. In addition, either condition can be associated with coeliac disease. For a long time patients with microscopic colitis were treated with non-specific anti-diarrhoeal agents, anti-inflammatory agents such as mesalazine, or systemic steroids, but with disappointing results. Bismuth subsalicylate was reported to be effective in a small controlled series of patients with collagenous colitis. Now, randomised controlled trials have shown the effectiveness of budesonide over placebo in collagenous colitis and more recently in lymphocytic colitis. The histologic response is variable, but a decrease in the subepithelial collagen layer and a decrease in the lymphoplasmocytic infiltrate in the lamina propria is observed in about half of the patients. In general, patients respond within 2 weeks with no major side effects. However, relapse is common (63–80% of patients) when budesonide is stopped. Longer-term treatment is effective but does not seem to reduce relapse rates upon discontinuation.

Cardiac arrest due to lymphocytic colitis: a case report

“…The etiology is multifactorial and it is unknown whether the two subtypes are pathogenetically related [2]. The peak incidence of the disease is in the age range of 55 to 70 years and occurs predominantly in women (female to male ratio, 2 to 3:1) [3]. Although most cases are idiopathic, certain drugs can induce the condition, particularly nonsteroidal anti-inflammatory drugs but also acetylsalicylic acid [3].…”

“…The peak incidence of the disease is in the age range of 55 to 70 years and occurs predominantly in women (female to male ratio, 2 to 3:1) [3]. Although most cases are idiopathic, certain drugs can induce the condition, particularly nonsteroidal anti-inflammatory drugs but also acetylsalicylic acid [3]. Other drugs which can induce colitis include acarbose, ranitidine, sertraline, ticlopidine, flutamide, omeprazole and simvastatin [4].…”

Clinical cases of microscopic colitis: Diagnosis and treatment issues. Case report

“…По данным кокрановского анализа эффективности лечения КК показано, что при лечении будесонидом отношение шансов клинического ответа чрезвычайно высоко -12,3 (95% доверительный интервал 5,5-27,5); NNT (number needed to treat) -число пациентов, которых нужно пролечить для получения результата у одного, равно 2. Полученные результаты подчеркивают высокую эффективность будесонида в лечении КК [8]. При анализе базы данных всех пациентов с КР, достигнутой применением будесонида, отмечено, что у 59% из них КР развилась через 2 нед терапии.…”