Collagenous colitis

Collagenous colitis
Classification and external resources
Micrograph of collagenous colitis. H&E stain.
DiseasesDB	2955
eMedicine	med/1351
MeSH	D046729

Collagenous colitis is an inflammatory colonic disease with peak incidence in the 5th decade of life, affecting women more than men. Its clinical presentation involves watery diarrhea, usually in the absence of rectal bleeding. It is often classified under the umbrella entity microscopic colitis, along with a related condition, lymphocytic colitis.

Diagnosis

On colonoscopy, the mucosa of the colon typically looks normal, but biopsies of affected tissue usually show deposition of collagen in the lamina propria, which is the area of connective tissue between colonic glands. Radiological tests, such as a barium enema are typically normal.

Causes

The exact cause of collagenous colitis is unknown, but the effects of non-steroidal anti-inflammatory drugs such as diclofenac are commonly implicated.^{[citation needed]} The other group of agents most commonly associated with collagenous colitis are the selective serotonin reuptake inhibitors used in the treatment of depression.

Treatment

Treatment of collagenous colitis is often challenging, and many agents have been used therapeutically:

• Bismuth agents, including Pepto-Bismol
• 5-aminosalicylic acid
• Budesonide
• Immunosuppressants, including azathioprine
• Corticosteroids

Pilot investigational studies have shown some evidence of possible benefit for both Boswellia serrata extract and specific strains of probiotics in the treatment of collegenous colitis, although larger sample sizes are needed to confirm the results.^[1][2][3]

Disease associations

An association between collagenous colitis and celiac disease has been reported, but there is no evidence that dietary restrictions used in celiac disease management are of benefit in collagenous colitis therapy.

There have also been reports of an association between collagenous colitis and lymphoma.

See also

• Colitis
• Lymphocytic colitis

References

1. ^ Madisch A, Miehlke S, Eichele O, Mrwa J, Bethke B, Kuhlisch E, Bästlein E, Wilhelms G, Morgner A, Wigginghaus B, Stolte M. (2007 Dec). "Boswellia serrata extract for the treatment of collagenous colitis. A double-blind, randomized, placebo-controlled, multicenter trial.". Int J Colorectal Dis. (22(12):2): 1445–51. doi:10.1007/s00384-007-0364-1. PMID 17764013. 
2. ^ Wildt S, Munck LK, Vinter-Jensen L, Hanse BF, Nordgaard-Lassen I, Christensen S, Avnstroem S, Rasmussen SN, Rumessen JJ. (2006 May). "Probiotic treatment of collagenous colitis: a randomized, double-blind, placebo-controlled trial with Lactobacillus acidophilus and Bifidobacterium animalis subsp. Lactis.". Inflamm Bowel Dis. (12(5)): 395–401. doi:10.1097/01.MIB.0000218763.99334.49. PMID 16670529. 
3. ^ Tromm A, Niewerth U, Khoury M, Baestlein E, Wilhelms G, Schulze J, Stolte M. (2004 May). "The probiotic E. coli strain Nissle 1917 for the treatment of collagenous colitis: first results of an open-label trial.". Z Gastroenterol. (42(5)): 365–9. doi:10.1055/s-2004-812709. PMID 15136935. 

• Chande N, Driman DK, Reynolds RP (March 2005). "Collagenous colitis and lymphocytic colitis: patient characteristics and clinical presentation". Scand. J. Gastroenterol. 40 (3): 343–7. doi:10.1080/00365520510011623. PMID 15932175.