Protein-losing Enteropathy Associated with Collagenous Colitis Cured by Withdrawal of a Proton Pump Inhibitor

Abstract

A 63-year-old woman was admitted with symptoms of watery diarrhea and generalized edema lasting for five months. She had been administered 15 mg/day of lansoprazole. Laboratory findings revealed severe hypoproteinemia with normal liver, renal, thyroid and adrenal functions and no proteinuria. Colonoscopy revealed edematous mucosa, minor diminished vascular transparency and apparent longitudinal linear lacerations. The histopathological findings were compatible with a diagnosis of collagenous colitis (CC). Protein leakage from the colon was identified on 99m Tc-human serum albumin scintigraphy. The results indicated CC associated with protein-losing enteropathy. Discontinuing lansoprazole ameliorated the watery diarrhea and generalized edema, increased the serum albumin level and improved the hypoproteinemia.

Acute onset collagenous colitis associated with protein‐losing enteropathy

“…Association of protein‐losing enteropathy is generally acknowledged to be rare, and we could not find any studies on the actual frequency. In some case reports, protein leakage from the colon was identified by Technetium‐99m human serum albumin scintigraphy . With the same method, we were able to prove the existence of protein‐losing enteropathy in this case.…”

“…In some case reports, protein leakage from the colon was identified by Technetium-99m human serum albumin scintigraphy. 7,8 With the same method, we were able to prove the existence of protein-losing enteropathy in this case.…”

Evaluation by MR Enterocolonography of Lansoprazole-induced Collagenous Colitis Accompanied with Protein-losing Enteropathy

“…This result suggests that the intestine is severely damaged in LPZ-induced CC and thus suffers protein loss, although the quantification of fecal protein was not clarified except in present case. In addition to our investigation, there are already 4 case reports of CC with PLE ( 2 - 5 ), two from the USA and two from Japan. Among the 5 cases including ours, LPZ was taken in 3 cases, which were only from Japan (100% in Japanese cases of CC with PLE) ( 3 , 5 ).…”

“…In addition to our investigation, there are already 4 case reports of CC with PLE ( 2 - 5 ), two from the USA and two from Japan. Among the 5 cases including ours, LPZ was taken in 3 cases, which were only from Japan (100% in Japanese cases of CC with PLE) ( 3 , 5 ). This result also implies that LPZ might be a possible causal agent of hypoalbuminemia/PLE, especially in Asian patients.…”

“…Collagenous colitis (CC), characterized by the deposition of a collagen band in the colonic sub-epithelium, is supposed to be the cause of persistent diarrhea ( 1 ), while also rarely leading to protein-losing enteropathy (PLE) ( 2 - 5 ). The pathophysiology of CC is still unclear, but some drugs such as proton-pump inhibitors (PPIs), especially lansoprazole (LPZ), and non-steroidal anti-inflammatory drugs (NSAIDs) are reported to be causative or triggering agents and the cessation of these drugs can sometimes improve the diarrhea symptoms ( 1 ).…”