scholarly journals Lymphocytic and Collagenous Colitis: The Emerging Entity of Microscopic Colitis. An Update on Pathophysiology, Diagnosis and Management

2003 ◽  
Vol 17 (7) ◽  
pp. 425-432 ◽  
Author(s):  
Ayman A Abdo ◽  
Stefan J Urbanski ◽  
Paul L Beck
Keyword(s):  
Chronic Diarrhea ◽  
Adult Population ◽  
Collagenous Colitis ◽  
Lymphocytic Infiltration ◽  
Microscopic Colitis ◽  
Common Cause ◽  
Stepwise Approach ◽  
Histological Assessment ◽  
Oral Corticosteroids ◽  
Radiological Examinations

Microscopic colitis (MC) encompasses the two morphologically distinct entities of collagenous colitis (CC) and lymphocytic colitis (LC). MC was first described less than 30 years ago but is presently recognized as a relatively common cause of chronic diarrhea in the adult population. Remarkably, up to 10% of adults who have a colonoscopy for the investigation of chronic diarrhea, and have endoscopically normal appearing mucosa, may have MC. Patients with MC generally present with chronic diarrhea, which can be associated with cramping and bloating. Endoscopic and radiological examinations are usually normal. Histological assessment reveals inflammation consisting predominantly of lymphocytic infiltration, and a thickened subepithelial collagen band is diagnostic of CC. Both LC and CC can be associated with autoimmune diseases such as celiac disease, diabetes, arthritis and thyroiditis, yet the mechanisms involved in the pathogenesis remain unclear. Emerging studies suggest that a stepwise approach be taken in the medical management of MC. This approach includes antidiarrheal agents and stopping of any offending agents; budesonide or bismuth subsalicylate; and cholestyramine or 5-acetylsalicylic acid agents. In resistant cases, oral corticosteroids and other immune modulatory therapy have been used.

scholarly journals Familial Microscopic Colitis

2001 ◽  
Vol 15 (5) ◽  
pp. 341-343 ◽  
Author(s):  
Ayman Assad Abdo ◽  
Peter Jeffrey Zetler ◽  
Lawrence S Halparin
Keyword(s):  
Chronic Diarrhea ◽  
Present Report ◽  
Disease Process ◽  
Collagenous Colitis ◽  
Microscopic Colitis ◽  
Familial Occurrence ◽  
Lymphocytic Colitis ◽  
The Third ◽  
Inflammatory Conditions ◽  
Colonic Biopsy

Collagenous and lymphocytic colitis are two inflammatory conditions of the colon that are often collectively referred to as microscopic colitis. The present report describes what is believed to be the third published case of familial microscopic colitis. A 55-year-old woman who suffered from chronic diarrhea was diagnosed with lymphocytic colitis on colonic biopsy. Subsequently, her 36-year-old daughter was diagnosed with collagenous colitis. The familial occurrence of these diseases may support an immunological hypothesis for their etiology. In addition, it supports the assumption that collagenous and lymphocytic colitis are two manifestations of the same disease process rather than two completely separate entities. The familial tendency of this disease may make a case for early colonoscopy and biopsy in relatives of patients diagnosed with microscopic colitis if they present with suggestive symptoms.

scholarly journals Microscopic Colitis: Epidemiology, Pathophysiology, Diagnosis and Current Management—An Update 2013

2013 ◽  
Vol 2013 ◽  
pp. 1-12 ◽  
Author(s):  
Martin Alexander Storr
Keyword(s):  
Colonic Mucosa ◽  
Chronic Diarrhea ◽  
Treatment Options ◽  
Correct Diagnosis ◽  
Collagenous Colitis ◽  
Microscopic Colitis ◽  
Normal Colonic Mucosa ◽  
Clinical Value ◽  
Current Management ◽  
And Gender

Microscopic colitis is a common cause of chronic diarrhea. Over the last years the incidence and the prevalence of microscopic colitis are rising and this rise is largely attributed to a rising awareness, and concomitantly an increasing number of diagnoses are made. Patients with microscopic colitis report watery, nonbloody diarrhea of chronic, intermittent, or chronic recurrent course. Following an unremarkable physical examination the diagnosis of microscopic colitis is made by colonoscopy, which shows essentially a normal colonic mucosa. Biopsies taken during the colonoscopy procedure will then finally establish the correct diagnosis. Histological workup can then confirm a diagnosis of microscopic colitis and can distinguish the two distinct histological forms, namely, collagenous colitis and lymphocytic colitis. Presently both forms are diagnosed and treated in the same way; thus the description of the two forms is not of clinical value, though this may change in future. Depending on the patients age and gender 10–30% of patients investigated for chronic diarrhea will be diagnosed with microscopic colitis if biopsies are taken. Microscopic colitis is most common in older patients, especially in female patients and is frequently associated with autoimmune disorders and the consumption of several drugs. This review summarizes the present knowledge of the epidemiology, the pathophysiology, and the diagnosis of microscopic colitis and discusses the former and the present treatment options.

scholarly journals Epidemiology and Clinical Outcomes of Microscopic Colitis: Preliminary Results From the Loyola University Microscopic Colitis Registry (LUMiCoR)

2021 ◽  
Vol 8 ◽  
Author(s):  
Poornima Oruganti ◽  
Rehmat Awan ◽  
Xianzhong Ding ◽  
Michael Wesolowski ◽  
Ayokunle T. Abegunde
Keyword(s):  
Logistic Regression ◽  
Chart Review ◽  
Tricyclic Antidepressants ◽  
Chronic Diarrhea ◽  
Total Sample ◽  
Descriptive Statistics ◽  
Microscopic Colitis ◽  
Common Cause ◽  
Term Data

Microscopic colitis (MC) is a common cause of chronic diarrhea with limited long-term data. We searched the pathology records at our institution from 2008 to 2018 to identify cases of MC. Total sample included patients with either a diagnosis of MC or incomplete MC (MCi).Chart review was performed and data were summarized for descriptive statistics. Logistic regression was used to estimate the unadjusted effects of predictors on MC. A total of 216 patients (88.32% white, 80.56% females, mean age 67.12 +/– 15.79) were studied; 50.00% had CC, 40.28% had LC and 9.72% had MCi. Majority (52.31%) were smokers and 21.84% of females were using some form of hormonal therapy. The odds of LC in reference to CC were significantly higher for those using tricyclic antidepressants (TCAs) (OR: 3.23, 95% C.I: 1.18–8.80, p = 0.02). The odds of smoking, statins, aspirin and beta-blocker use were decreased in MCi in reference to CC (all p < 0.05), 29 (74.35%) patients with unresolved symptoms underwent repeat colonoscopies with biopsies. One case of MCi resolved, 8 (72.73%) out of 11 cases of LC resolved, 2 (18.18%) continued to be LC and 1 (9.09%) transformed to CC, 8 (47.06%) out of 17 cases of CC resolved, 8 (47.06%) continued to be CC and 1 (5.88%) transformed to LC. Majority of patients had CC. TCA use resulted in increased odds of LC in reference to CC. Biopsies from repeat colonoscopies in some patients revealed changes in the pathological diagnoses raising the question of interchangeability of MC (CC to LC and vice versa).

scholarly journals Description of Colonoscopy and Histopathology of Chronic Diarrhea Causes in Non-Neoplasm: Literature Review

2021 ◽  
Vol 22 (1) ◽  
pp. 52-59
Author(s):  
Afifah Sakdyyah ◽  
Muhammad Begawan Bestari ◽  
Sri Suryanti
Keyword(s):  
Differential Diagnosis ◽  
Risk Factor ◽  
Literature Review ◽  
Chronic Diarrhea ◽  
Microscopic Colitis ◽  
Differential Diagnoses ◽  
Definite Diagnosis ◽  
Infectious Colitis ◽  
Common Cause

Chronic diarrhea is a diarrhea symptom which persists for ≥ 4 weeks as a symptom of a disease. Chronic diarrhea is a symptom which often becomes the patient’s cause to be referred to gastroenterology. In general, the prevalence of chronic diarrhea is approximated to be 5% in each populations, but there are obstacles in diagnosing the cause of chronic diarrhea, due to many differential diagnoses of the cause of chronic diarrhea. The cause of chronic diarrhea could be neoplasm and non-neoplasm. In several studies, through results of colonoscopy and histopathology, it was found that the most common cause of chronic diarrhea was non-neoplasm, including IBD, microscopic colitis as a risk factor, and infectious colitis as a differential diagnosis. Each of those diseases has similar symptoms, but different pathological description. Through descriptions of colonoscopy and histopathology of chronic diarrhea causes, it is possible to differentiate each non-neoplasm causes of chronic diarrhea. It could facilitate in finding the differences among the causes of chronic diarrhea especially in non-neoplasm cases, therefore possibly establishing a definite diagnosis. 

scholarly journals A196 MORE MICROSCOPIC THAN WAS THOUGHT: A RARE CASE OF ISOLATED LYMPHOCYTIC ILEITIS WITHOUT MICROSCOPIC COLITIS

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 219-220
Author(s):  
K S Singh ◽  
R Yanofsky ◽  
D Haegert ◽  
Z Gao ◽  
T Bessissow
Keyword(s):  
Terminal Ileum ◽  
Oral Intake ◽  
Collagenous Colitis ◽  
Lymphocytic Infiltration ◽  
Chronic Inflammatory Disease ◽  
Microscopic Colitis ◽  
Lymphocytic Colitis ◽  
Colonic Disease ◽  
Normal Colonic Mucosa ◽  
Macroscopic Appearance

Abstract Background Microscopic colitis (MC) is a chronic inflammatory disease of the colon characterized by lymphocytic infiltration with (collagenous colitis) or without (lymphocytic colitis) the expansion of collagen fibres, and the normal macroscopic appearance of the mucosa on ileocolonoscopy. Recent studies have shown that the ileum may be involved in MC, occurring concurrently with colonic disease, however there is sparse literature on isolated lymphocytic ileitis without colitis. Aims We describe the case of isolated small bowel lymphocytosis without evidence of lymphocytic colitis to highlight the utility of random biopsies of the terminal ileum in cases where microscopic colitis is a diagnostic consideration. Methods A 70-year-old female known for cutaneous mastocytosis presented with six weeks of abdominal pain, non-bloody diarrhea, intolerance to oral intake and significant weight loss. Computed-tomography showed evidence of possible mesenteric panniculitis. Colonoscopy revealed a normal colon and normal-appearing mucosa of the terminal ileum. Random mucosal biopsies were taken to assess for microscopic colitis, with terminal ileal biopsies revealing significant lymphocytic infiltration consistent with lymphocytic ileitis. Biopsies throughout the colon revealed normal colonic mucosa without evidence of concurrent microscopic colitis. Gastroscopy was macroscopically unremarkable and random biopsies in the stomach and duodenum were negative for Helicobacter pylori and lymphocytosis. Immunostaining of the gastric, duodenal, terminal ileal and colonic biopsy specimens were negative for CD25, CD117 and tryptase, indicating the absence of gastrointestinal mastocytosis. Results The patient was diagnosed with lymphocytic ileitis and given the known response of MC to budesonide, she was treated with eight weeks of budesonide with clinical improvement leading to remission of her symptoms. Conclusions This case illustrates a rare incidence of isolated ileal microscopic ileitis without colitis that responded well to standard MC treatment, thereby underscoring the utility of random biopsies in the terminal ileum and throughout the colon when microscopic colitis is on the differential diagnosis. Funding Agencies None

scholarly journals CT Scan Evaluation of Prevalence of Paradoxical Middle Turbinate In Adult Population of Bihar

2020 ◽  
Vol 6 (1) ◽  
pp. 01-04
Author(s):  
Raag Reeti ◽  
Md Jawed Akhtar ◽  
Avanish Kumar ◽  
Binod Kumar ◽  
Rajiv Ranjan Sinha
Keyword(s):  
Convex Surface ◽  
Adult Population ◽  
Middle Turbinate ◽  
Lateral Wall ◽  
Anatomical Variations ◽  
Sinus Surgery ◽  
P Value ◽  
Test Results ◽  
Common Cause ◽  
Exact Test

Introduction: Middle turbinate overlying the middle meatus is the most important anatomic area in the lateral wall of the nose. It is a thinsheet of bone which curves in different planes very similar to a dried leaf. Paradoxical Middle Turbinate (PMT) is the abnormal curvatureof middle turbinate, where the convex surface faces laterally instead of its usual medial curvature and may block the drainage pathway ofmiddle meatus. The present study aimed at observing the prevalence of the paradoxical middle turbinate in the adult population of Bihar. Subjects and Methods: This was a retrospective study being conducted on 150 patients who presented to the Department of Radiodiagnosis. Their CT scans were analysed for the presence of paradoxical middle turbinate. The results were analysed as percentage and ‘p’ value was calculated using Fischer’s Exact Test. Results: Prevalence of Paradoxical Middle Turbinate was observed in 28 cases i.e. 18.6% cases; 16 in males and 12 in females. ‘p’ value was 0.677 on applying Fisher’s Exact test. Conclusion: Anatomical variations of the paranasal sinus region like paradoxical middle turbinate are quite common cause of diseases involving paranasal sinuses and they must be searched for by the surgeons planning any endoscopic sinus surgery. This study attempted to provide the prevalence of the paradoxical middle turbinate which will definitely help the FESS surgery and its outcomes.

scholarly journals Case Report: Ramipril and microscopic colitis; a necessary tool of cardiologists can rarely be devastating for patients

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 1113
Author(s):  
Saad Hasan ◽  
Haseeb Ur Rahman ◽  
Stephen Hutchison
Keyword(s):  
Case Report ◽  
Enzyme Replacement Therapy ◽  
Replacement Therapy ◽  
Pancreatic Enzyme ◽  
Collagenous Colitis ◽  
Microscopic Colitis ◽  
Chronic Diarrhoea ◽  
Converting Enzyme Inhibitors ◽  
Enzyme Replacement ◽  
Pancreatic Enzyme Replacement Therapy

Angiotensin converting enzyme inhibitors could lead to severe diarrhoea related to microscopic colitis. Few of such cases have been reported before and this serious problem, from a widely used class of drugs in hypertension and heart failure, needs to be more recognised. We describe the case of collagenous colitis related to ramipril use in the following case report. A 74-year-old farmer who had a history of triple vessel coronary artery disease was admitted to district general hospital with non-ST elevation myocardial infarction. He had known alcohol-related chronic pancreatitis with chronic diarrhoea as a complication, which was managed with pancreatic enzyme replacement therapy. However, he developed severe worsening of diarrhoea causing bowel incontinence and nocturnal symptoms during his admission to hospital. The explosive and watery nature of diarrhoea with urgency was so troublesome that it delayed coronary revascularisation and lead him to have significant psychological distress and low mood while nocturnal bowel motions meant he was unable to sleep. He was compliant with his pancreatic enzyme replacement therapy during this period. Infective causes were ruled out by stool microbiology examination and coeliac disease by oesophagogastroscopy and biopsy. It was noticed that he was recently prescribed ramipril that was later stopped as a possible diarrhoea trigger. Diarrhoea started settling immediately and resolved to his baseline within a week. A colonoscopy was performed in the meantime and biopsies demonstrated microscopic colitis (MC). He did not tolerate budesonide well so was stopped. However, a follow-up colonoscopy with biopsy in two months showed resolution of MC.

scholarly journals Microscopic colitis: A literature review

2016 ◽  
Vol 62 (9) ◽  
pp. 895-900 ◽  
Author(s):  
ANA PAULA HAMER SOUSA CLARA ◽  
FLÁVIA DRAGO MAGNAGO ◽  
JULIANA NEVES FERREIRA ◽  
THAIS GAGNO GRILLO
Keyword(s):  
Scientific Evidence ◽  
Collagenous Colitis ◽  
Gastrointestinal Disorder ◽  
Normal Mucosa ◽  
Term Treatment ◽  
Diagnostic Methods ◽  
Microscopic Colitis ◽  
Older Individuals ◽  
Short Term Treatment ◽  
Pubmed Database

SUMMARY Microscopic colitis (MC) refers to chronic inflammation of the colon which is characterized by histologic changes at the level of a radiologically and endoscopically normal mucosa. It is a common cause of chronic non-bloody diarrhea that occurs primarily in older individuals; however, there are few studies in the literature with strong scientific evidence compared to other inflammatory bowel diseases (IBD), which limits the knowledge of physicians and pathologists. This article aims to review the information on MC, describing diagnostic methods and drugs available for treatment. We conducted a search of the Pubmed database and CAPES Portal using the keywords “microscopic colitis”, “collagenous colitis”, “lymphocytic colitis”, and “review” for selection of articles published between 1996 and 2015 related to the topic. Based on the studies discussed in this review, we conclude that MC is a relatively new gastrointestinal disorder, most studies are incipient particularly with respect to pathophysiology and immunology, and budesonide is the best documented short-term treatment. However, further studies are needed to elucidate the best strategy for treatment in the long term.

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