Collagenous colitis presenting with bloody diarrhea and rectal erosions in a patient with celiac disease: a case report

Abstract

Introduction: Collagenous colitis (CC) is a rare condition that is known to complicate inflammatory bowel diseases, but its relationship with celiac disease (CD) is more controversial. Aims: To report a case of CC that developed in a patient with CD and was manifested by rectal erosions at onset. Case report: A 46-year-old woman was diagnosed with CD and placed on a gluten-free diet. After an initial phase of improvement, her diarrhea resumed, and she began to lose weight. Despite strict adherence to the diet, the patient's diarrhea worsened. One year after diagnosis, colonoscopy was performed and mucosal biopsies were collected, but the findings were inconclusive. Two months later, the previously watery diarrhea became bloody, and a second colonoscopy was performed. Histological examination of the biopsy specimens revealed rectal erosions and CC. The patient was treated with oral prednisone plus mesalazine for 6 weeks, and her symptoms immediately disappeared. Mesalazine was continued, and the prednisone was then gradually replaced with budesonide. Six months after the CC diagnosis, the patient was asymptomatic, and a second colonoscopy revealed no macroscopic or microscopic signs of CC. She continues to take mesalazine and budesonide. An attempt to taper the dosage of the latter drug from 6 to 3 mg/day caused the reappearance of the diarrhea. Conclusion: CC is rarely associated to CD and can cause bloody diarrhea. Excellent results were obtained in this case with prednisone plus mesalazine followed by maintenance therapy with budesonide plus mesalazine.

Correlation Between IgA Tissue Transglutaminase Antibody Ratio and Histological Finding in Celiac Disease

“…We selected only patients with high pretest probability of CD (suggestive symptoms, risk factors, comorbid conditions) and with positivity of anti‐TTG antibodies and EMA. Some clinical conditions, such as liver disease, rheumatoid arthritis, and inflammatory bowel disease, can cause a falsely positive anti‐TTG result (30,31), but when both anti‐TTG and EMA are positive in a patient with suggestive symptoms and/or risk factors, the probability that the patient had CD is extremely high, almost 100% (7). Furthermore, most Italian laboratories use the diagnostic protocol proposed by the Autoimmunity and Allergology Study Group of the Italian Society of Laboratory Medicine, which provides an initial screening with a highly sensitive test (anti‐TTG) confirmed, if positive, by EMA (32).…”

Macroscopic findings, incidence and characteristics of microscopic colitis in a large cohort of patients from the United Kingdom

“…More recently, several larger cohorts have described subtle macroscopic findings in up to 30% of individuals with MC, occurring with greater frequency in collagenous colitis [20]. There have also been case reports describing macroscopic changes sufficient to raise a clinical suspicion of classical inflammatory bowel disease (IBD) at the time of colonoscopy [19,21]. Given these findings, the adequacy of the term 'microscopic' colitis has been questioned [22,23,24].…”