Colonic mucosal tears in collagenous colitis

Wickbom, Anders; Lindqvist, Magnus; Bohr, Johan; Ung, Kjell-Arne; Bergman, Jan; Eriksson, Sara; Tysk, Curt

doi:10.1080/00365520500453473

Cited by 56 publications

(40 citation statements)

References 21 publications

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“…Recently new endoscopic findings have been added: red spots [13] , aphthoid ulcer [14] , ulcer [6] , mucosal tears [15,16] , hemorrhagic lacerations [17] , and longitudinal ulcers [18] . In our case, distinct diffuse cloudiness of the mucosa was observed on two occasions in this patient with collagenous colitis.…”

Section: Discussionmentioning

confidence: 99%

Lansoprazole-associated collagenous colitis: Diffuse mucosal cloudiness mimicking ulcerative colitis

Chiba¹,

Sugawara²,

Tozawa³

et al. 2009

WJG

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There have only been a few reports on lansoprazoleassociated collagenous colitis. Colonic mucosa of collagenous colitis is known to be endoscopically normal. We present a case of collagenous colitis where the mucosa showed diffuse cloudiness mimicking ulcerative colitis. A 70-year-old woman developed watery diarrhea four to nine times a day. She had interstitial pneumonia at 67 and reflux esophagitis at 70 years. Lansoprazole 30 mg/d had been prescribed for reflux esophagitis for nearly 6 mo. Lansoprazole was withdrawn due to its possible side effect of diarrhea. Colonoscopy disclosed diffuse cloudiness of the mucosa which suggested ulcerative colitis. Consequently sulfasalazine 2 g/d was started. The patient's diarrhea dramatically disappeared on the following day. However, biopsy specimens showed subepithelial collagenous thickening and infiltration of inflammatory cells in the lamina propria, confirming the diagnosis of collagenous colitis. One month after sulfasalazine therapy was initiated, colonoscopic and histological abnormalities resolved completely. Five months later the diarrhea recurred. The findings on colonoscopy and histology were the same as before, confirming a diagnosis of collagenous colitis relapse. We found that the patient had begun to take lansoprazole again 3 mo ahead of the recent diarrhea. Withdrawal of lansoprazole promptly resolved the diarrhea. Endoscopic and histological abnormalities were also completely resolved, similar to the first episode. Retrospectively, the date of commencement of sulfasalazine and discontinuation of lansoprazole in the first episode was found to be the same. We conclude that this patient had lansoprazole-associated collagenous colitis.

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Section: Discussionmentioning

confidence: 99%

Lansoprazole-associated collagenous colitis: Diffuse mucosal cloudiness mimicking ulcerative colitis

Chiba¹,

Sugawara²,

Tozawa³

et al. 2009

WJG

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“…Barium enema and colonoscopy are usually normal, although subtle mucosal changes can be seen such as edema, erythema and abnormal vascular pattern [18,20] . Tears of colonic mucosa have occasionally been seen during colonoscopy, which might be a sign of increased risk of colonic perforation during the procedure [26,[77][78][79] . In the future, the use of confocal laser microscopy may enable in vivo diagnosis of MC [80][81][82] .…”

Section: Diagnosismentioning

confidence: 99%

Diagnosis and management of microscopic colitis

Tysk¹,

Bohr²,

Nyhlin³

et al. 2008

WJG

Self Cite

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Microscopic colitis, comprising collagenous and lymphocytic colitis, is characterized clinically by chronic watery diarrhea, and a macroscopically normal colonic mucosa where diagnostic histopathological features are seen on microscopic examination. The annual incidence of each disorder is 4-6/100 000 inhabitants, with a peak incidence in 60-70-year-old individuals and a noticeable female predominance for collagenous colitis. The etiology is unknown. Chronic diarrhea, abdominal pain, weight loss, fatigue and fecal incontinence are common symptoms, which impair the health-related quality of life of the patient. There is an association with other autoimmune disorders such as celiac disease, diabetes mellitus, thyroid disorders and arthritis. Budesonide is the best-documented shortterm treatment, but the optimal long-term strategy needs further study. The long-term prognosis is good and the risk of complications including colonic cancer is low.

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“…While CC has been described as an unexplained inflammatory bowel disease, drug-induced CC and possible involvement of autoimmune mechanisms in the onset of CC have been reported [5,6,7]. In Japan, most of the recently reported cases had a history of use of LPZ, a type of PPI, and some studies have suggested that endoscopically documented longitudinal linear lacerations of the mucosa might be the cause of CC [8,9].…”

Section: Discussionmentioning

confidence: 99%

“…coarse and nodular surface of the mucosa [4]. Crowded tortuous pattern of the vasculature plus diffuse cloudiness of the mucosa, red spots on the mucosa and longitudinal linear lacerations of the mucosa (mucosal tears, linear mucosal defect [3,5]) in specific colonic segments were evaluated.…”

Section: Methodsmentioning

confidence: 99%

Endoscopic and Histopathological Evaluation of Collagenous Colitis

Narabayashi¹,

Murano²,

Egashira

et al. 2012

Digestion

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Collagenous colitis (CC) is a well-known cause of chronic non-bloody diarrhea, especially in elderly women. CC is characterized histopathologically by an increase in the thickness of the subepithelial collagen layer to at least 10 µm, epithelial damage, and chronic inflammation of the lamina propria. Generally, the colonic mucosa in CC is macroscopically normal, although minor, non-specific abnormalities may be found. Due to the recent advancement of endoscopic and diagnostic technologies, however, microscopic mucosal abnormalities and specific longitudinal linear lacerations of the mucosa characteristic of CC have been identified. The association of CC with non-steroidal anti-inflammatory drugs and proton pump inhibitors has also been reported. Since definitive diagnosis of CC has to rely on pathologically documented collagen bands and mononuclear infiltration, the efficiency and precision of colonic biopsy need to be improved. Of the 29 CC patients that we have encountered at our institution, it was in 15 of 29 cases that the endoscopic finding that we performed a biopsy on was apparent. Our comparison of the endoscopic and histopathological findings of CC in the 15 patients showed that the mucosa frequently appeared coarse and nodular on the surface of the mucosa, which was also significantly thicker in collagen bands, demonstrating a strong correlation between collagen band formation and CC. Also, the coarse and nodular surface of the mucosa was most frequently seen affecting the proximal colon. The results suggest that endoscopic observation and biopsy of the proximal colon, where a coarse and nodular surface of the mucosa is often found, may be useful for confirmation of the diagnosis in patients with suspected CC.

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Colonic mucosal tears in collagenous colitis

Cited by 56 publications

References 21 publications

Lansoprazole-associated collagenous colitis: Diffuse mucosal cloudiness mimicking ulcerative colitis

Lansoprazole-associated collagenous colitis: Diffuse mucosal cloudiness mimicking ulcerative colitis

Diagnosis and management of microscopic colitis

Endoscopic and Histopathological Evaluation of Collagenous Colitis

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