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

Abstract

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 Lansoprazole was withdrawn due to its possible side effect of diarrhea.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.

Lansoprazole-induced microscopic colitis: An increasing problem? Results of a prospecive case-series and systematic review of the literature

“…Few studies have investigated possible differences between idiopathic LC and CC, without evidence of different symptoms [19]. However, colonic tears seen at endoscopy and associated with risk of perforation have only been reported in CC [15][16][17]20].…”

“…According to their criteria, considering both chronological (time between drug introduction and onset of diarrhoea) and causality parameters (based on proper exclusion of other potential causes) drug responsibility was definite or at least probable for all eight case observed. On the other hand, in the 25 cases of LAN-related MC retrieved after literature search [10][11][12][13][14][15][16][17][18], chronological parameters and causative factors were not systemically analysed (see Tables 1 and 2). …”

“…However, the use of LAN has been associated with a relatively higher incidence of diarrhoea, up to 10% [9]. Although not all cases of diarrhoea in patients treated with LAN should be considered MC-related, a number of single case reports, or case series linked MC to LAN use [10][11][12][13][14][15][16][17][18].…”

A case of collagenous colitis with cryptogenic organizing pneumonia

“…And interstitial pneumonia and COP sometimes complicates other organ disorders and connective tissue disease [2,3]. As long as we examined, only two case reports discussing about interstitial pneumonia and collagenous colitis were reported so far [4,5]. Recently, aberrant T cell response and Th1 cytokine were reported to be involved in inflammation of collagenous colitis [6].…”

“…Finally, this case was diagnosed as having lansoprazole induced collagenous colitis. Already there are many reports about relevance between PPI and collagenous colitis [5,[7][8][9]. This case had a past history of administration of rabeprazole against peptic ulcer, and there was no diarrhea during administration.…”