Abstract:In a prospective study, the clinicopathological effect of prednisolone was evaluated in six patients with collagenous colitis. Prednisolone was associated with a significant decrease in stool frequency. However, the effect was transitory, since the diarrhoea recurred when prednisolone treatment was discontinued. There was a trend toward a diminished inflammatory response in the post-treatment biopsies, but the thickness of the collagen band remained unchanged, except in one patient. Until the results of furthe… Show more
“…The effects of corticosteroids on eosinophils are several, including diminished recruitment, downregulation of activation, enhanced eosinophil apoptosis, and increased tissue eosinophil clearance. [51][52][53] A previous prospective study on 6 CC patients reports a reduction in the numbers of eosinophils after oral prednisolone treatment, 54 in line with our results. We also revealed that eosinophil activation is down-regulated after 8 weeks of budesonide treatment.…”
In the present study we demonstrated that the inflammation in CC is characterized by activated eosinophils but there is no neutrophil activity. CD4+ and CD8+ T-cells are increased in numbers in active CC but, surprisingly, they had a lower grade of activity than in control subjects. The major finding of this study is that budesonide treatment restores the normal activation of eosinophils and T-cells, accompanied by clinical remission.
“…The effects of corticosteroids on eosinophils are several, including diminished recruitment, downregulation of activation, enhanced eosinophil apoptosis, and increased tissue eosinophil clearance. [51][52][53] A previous prospective study on 6 CC patients reports a reduction in the numbers of eosinophils after oral prednisolone treatment, 54 in line with our results. We also revealed that eosinophil activation is down-regulated after 8 weeks of budesonide treatment.…”
In the present study we demonstrated that the inflammation in CC is characterized by activated eosinophils but there is no neutrophil activity. CD4+ and CD8+ T-cells are increased in numbers in active CC but, surprisingly, they had a lower grade of activity than in control subjects. The major finding of this study is that budesonide treatment restores the normal activation of eosinophils and T-cells, accompanied by clinical remission.
“…Collagenous colitis is unrelated to other forms of inflammatory bowel disease, such as chronic ulcerative colitis and Crohn's disease, and it requires a different patient management [7,20], although some evidence exists about transitions from collagenous colitis towards ulcerative colitis and from lymphocytic colitis to collagenous colitis. Hence, correct diagnosis is of clinical importance for identifying the cause of the clinical symptoms and to avoid inappropriate (over)treatment [18]. However, in cases that do not show pronounced subepithelial band formation, histological diagnosis is difficult and sometimes inconclusive.…”
Collagenous colitis is a rare cause of chronic watery diarrhea. In this condition, endoscopic findings are usually normal. Currently, the diagnosis relies on the histological presence of thick subepithelial bands of collagen deposits and an inflammatory infiltrate within the mucosa. However, these subepithelial bands may be developed only focally and may be too subtle to allow a definitive diagnosis upon routine hematoxylin and eosin (HE) and van Gieson's stainings. Recently, we and others were able to show a prominent staining of tenascin and type-VI collagen in the subepithelial band-like structures. In this study, we tested the diagnostic value of tenascin staining and type-VI collagen immunolocalization for the identification of collagenous colitis and compared it with conventional histology and histochemical detection of collagens. The analysis was based on 434 biopsy specimens of collagenous colitis, other forms of colitis, and normal mucosa. We were able to show that the immunohistochemical detection of increased amounts of tenascin, selectively in the subepithelial zone, is a specific test for collagenous colitis, with a sensitivity superior to conventional histological and histochemical detection, especially in minimal collagenous colitis (P<0.001). Of note, tenascin staining also allows the diagnosis of collagenous colitis in biopsies obtained only from the rectum and sigmoid colon, thus avoiding the need for colonoscopic investigations. Tenascin immunostaining is a simple and safe tool to complement conventional histological diagnostics in clinically and histopathologically unclear cases of diarrhea.
“…The following treatment schedules have so far been tried with little success or conflicting results: 5-ASA, sulfasalazine, metronidazole, mepacrine, cholestyramine and non-specific antidiarrheal medications [4,5,9,10]. Prednisone seems to be associated with a better clinical response [5,11], but toxicity is a major concern. In this small study, complete and partial responses to budesonide therapy in collagenous colitis were observed in 3 and 2 of the 5 patients, respectively.…”
Collagenous colitis is characterized by watery diarrhea and inflammatory infiltration associated with a subepithelial collagen deposit on colonic biopsies despite a normal or subnormal endoscopic appearance. We here describe 5 patients treated with the locally active steroid budesonide. Complete and partial response was observed in 3 and 2 patients, respectively. Budesonide thus seems to be of therapeutic benefit in collagenous colitis. Prospective randomized long-term studies are needed to support this hypothesis.
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