Microscopic Colitis and other Miscellaneous Inflammatory and Structural Disorders of the Colon

Yen, Eugene F.; Pardi, Darrell S.

doi:10.1002/9781118512074.ch74

Cited by 3 publications

(7 citation statements)

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“…[1][2][3][13][14][15][16] Overall, treatment approaches are based on symptom severity. 9,17,18 Experience from randomized controlled trials investigating maintenance budesonide in MC reported that 60% to 80% of patients receiving placebo had a relapse of symptoms within 2 to 8 weeks of stopping therapy, indicating that symptom recurrence is common without maintenance therapy. [1][2][3] Thus far, the paucity of data has led to limited recommendations from the American Gastroenterological Association on maintenance therapy; specifically, the use of budesonide at a dose of 6 mg daily to be tapered to the lowest possible dose based on symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…For collagenous colitis, there is a mixed inflammatory infiltrate in the lamina propria and a thickened subepithelial collagen band to 10 µm. In lymphocytic colitis, there is a similar but usually, more pronounced lamina propria infiltrate, with >20 intraepithelial lymphocytes per 100 epithelial cells needed to make the diagnosis 9. Patients with colorectal endoscopic biopsy specimens meeting these criteria were seen in the office to be consented for inclusion in the MC disease registry.…”

Section: Methodsmentioning

confidence: 99%

“…In lymphocytic colitis, there is a similar but usually, more pronounced lamina propria infiltrate, with > 20 intraepithelial lymphocytes per 100 epithelial cells needed to make the diagnosis. 9 Patients with colorectal endoscopic biopsy specimens meeting these criteria were seen in the office to be consented for inclusion in the MC disease registry. As per institutional practice, historical medications that have been implicated in causing MC were noted and removed, if possible, at the patient's clinical visit.…”

Section: Patientsmentioning

confidence: 99%

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Bile Acid Sequestrant Therapy in Microscopic Colitis

Northcutt

Gentile

Goldstein

et al. 2021

Journal of Clinical Gastroenterology

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Goals: There is an unmet need in investigating corticosteroid-sparing treatments for induction and maintenance of remission in microscopic colitis (MC). The authors' aim was to evaluate the outcomes of patients with MC treated with bile acid sequestrants (BAS).Background: MC is a common chronic diarrheal illness. Budesonide is effective induction therapy, but relapses are high after cessation of treatment.Study: Our cohort consisted of patients enrolled in our institutional MC registry, a biorepository of histology-confirmed diagnoses of MC. Patients receiving BAS for the treatment of MC were reviewed at each clinical visit for efficacy or ability to decrease budesonide maintenance dosing. Results:The authors included 79 patients (29 collagenous colitis and 50 lymphocytic colitis) with a median follow-up period of 35 months (range, 1 to 120). Most patients were female individuals (78%) and the median age was 69 years (range, 29 to 87). BAS therapy was used in 21 patients who were budesonide-naive, with a response rate of 76% (16/21). In patients treated previously with budesonide, 46 patients were budesonide-dependent and given BAS as maintenance therapy. Of these patients, 23 (50%) were able to decrease their budesonide dosing and 9 (20%) were able to stop budesonide completely. Seven of 46 patients (15%) stopped BAS because of intolerance, perceived lack of benefit, or treatment of concomitant diarrhea illness.Conclusions: BAS may be an effective corticosteroid-sparing option in the treatment of MC and should be considered after budesonide induction. Larger controlled studies are needed to confirm the efficacy for long-term maintenance and tolerability of BAS in patients with MC.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Patientsmentioning

confidence: 99%

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Bile Acid Sequestrant Therapy in Microscopic Colitis

Northcutt

Gentile

Goldstein

et al. 2021

Journal of Clinical Gastroenterology

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“…The bacterial theory suggests that gas-producing bacteria infiltrate the submucosa through breaches in the mucosa the presence of gas within the bowel walls [2][3][4]. The biochemical trigger dictates that fermentation of carbohydrates produce large amounts of hydrogen gas resulting in increased intestinal luminal pressure, forcing the gas through the mucosa and becoming trapped in the submucosa [5].…”

Section: Discussionmentioning

confidence: 99%

“…The pathogenesis of PC is likely multifactorial and poorly understood in the literature. Causes range from mechanical tears along the luminal surface of the bowel mucosa to gas producing bacterial infection such as Clostridium perfringens infiltrating the bowel submucosa [3][4][5]. We highlight a case of PC occurring postoperatively in a man who underwent excision of a left aorto-iliac mycotic aneurysm secondary to septic arthritis of his left first metatarsophalangeal joint.…”

Section: Introductionmentioning

confidence: 98%

Rare Case of Pneumatosis Coli following Mycotic Aneurysm excision

Peerbux¹

2021

JSCRI

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Pneumatosis coli (PC) is a rare radiological phenomenon of the presence of gas in the wall of the large intestine. It carries a large burden of morbidity and mortality. All patients should have their underlying cause of PC investigated and have targeted therapy. In this novel case, a 68-year-old man developed PC following an aorto-bilateral common iliac artery mycotic aneurysm excision. Fortunately, he was asymptomatic and underwent close surveillance of this condition until near resolution. This case highlights the need for correlation of the patient’s symptoms and clinical features with appropriate aetiology and pathogenesis mechanism of the disease to guide management and optimise health outcomes.

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The colitis may be microscopic, but the diarrhea is not: update on the treatment of microscopic colitis and immune checkpoint inhibitor colitis

Enwerem,

Yen

2023

Current Opinion in Gastroenterology

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Purpose of review Microscopic colitis is an inflammatory disease of the colon that presents as watery diarrhea with minimal to normal endoscopic changes on colonoscopy. It encompasses two common subtypes, lymphocytic colitis and collagenous colitis, which are both treated similarly. Immune checkpoint inhibitor colitis is among the most common immune-related adverse events. Endoscopic and histological findings range from normal colonic mucosa to inflammatory bowel like changes. This review article provides update in treatment and management of microscopic colitis and immune checkpoint inhibitor colitis (ICPi colitis). Recent findings Recent studies on microscopic colitis have focused on the successful use of immunomodulators such as biologics for treatment of budesonide refractory microscopic colitis cases. Microscopic colitis does not confer an added risk for colorectal cancer. With the increasing usage of immunotherapy agents, immune checkpoint inhibitor colitis is becoming more common. ICPi colitis can be successfully managed with steroids, with treatment stepped up to biologics for moderate to severe cases or for mild cases that do not respond to steroids. Immunotherapy agents can be carefully re-introduced in mild cases, after treatment of ICPi colitis. Summary Biologics can be used to treat budesonide refractory microscopic colitis. ICPi colitis can be managed with steroids and biologics in moderate to severe cases.

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Microscopic Colitis and other Miscellaneous Inflammatory and Structural Disorders of the Colon

Cited by 3 publications

References 180 publications

Bile Acid Sequestrant Therapy in Microscopic Colitis

Bile Acid Sequestrant Therapy in Microscopic Colitis

Rare Case of Pneumatosis Coli following Mycotic Aneurysm excision

The colitis may be microscopic, but the diarrhea is not: update on the treatment of microscopic colitis and immune checkpoint inhibitor colitis

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