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1.
Virchows Arch. 2019 Nov;475(5):573-578. doi: 10.1007/s00428-019-02629-2. Epub 2019 Jul 29.

Effects of subspecialty signout and group consensus on the diagnosis of microscopic colitis.

Author information

1
Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA.
2
Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA. rgonzal5@bidmc.harvard.edu.
3
Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA. rgonzal5@bidmc.harvard.edu.

Abstract

Microscopic colitis (MC) includes lymphocytic colitis (LC) and collagenous colitis (CC). Microscopic changes are required to establish these diagnoses. While criteria exist, interobserver variability has been reported previously. This has not been evaluated in the context of subspecialty signout (SSSO) or a consensus conference. We identified 133 colon biopsies diagnosed as LC, CC, MC, or normal but with mild changes insufficient for MC. All predated the introduction of SSSO at our institution. They were independently reviewed by three gastrointestinal (GI) pathologists. Cases lacking independent consensus were reviewed by the same pathologists in consensus conference to establish a final diagnosis. Individual diagnoses were compared with the consensus diagnoses, and consensus diagnoses were compared with original diagnoses made by GI and non-GI pathologists. Consensus diagnoses were normal (n = 34), LC (n = 57), and CC (n = 42). "Normal" was the diagnosis most commonly agreed upon independently (27/34 cases, P = 0.0073 versus LC, P = 0.0172 versus CC). The reviewing pathologists independently agreed with 80%, 80%, and 94% of consensus diagnoses (κ = 0.70, 0.69, and 0.91). The group consensus agreed with the diagnoses in 49 of 58 (84%) cases originally signed out by non-GI pathologists (κ = 0.77) and in 44 of 57 (77%) cases originally signed out by GI pathologists (κ = 0.63). Good interobserver agreement exists for MC, though whether GI subspecialty training improves agreement remains unclear. Group consensus may aid in diagnosis of difficult/borderline MC cases.

KEYWORDS:

Collagenous colitis; Interobserver variability; Lymphocytic colitis; Microscopic colitis; Subspecialty signout

PMID:
31359149
DOI:
10.1007/s00428-019-02629-2
[Indexed for MEDLINE]
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2.
BMJ Case Rep. 2019 Jun 6;12(6). pii: e228092. doi: 10.1136/bcr-2018-228092.

Microscopic colitis impacts quality of life in older people.

Author information

1
Department of Medicine of the Elderly, Royal Infirmary of Edinburgh, Edinburgh, UK.

Abstract

This report describes a frail 92-year-old woman with dementia who presented with a year's history of chronic watery non-bloody diarrhoea. She had abdominal bloating, weight loss, faecal urgency, nocturnal stools and developed faecal incontinence. Her serum C reactive peptide and faecal calprotectin were elevated. Flexible sigmoidoscopy was macroscopically normal, but demonstrated histological features of microscopic colitis (MC) in sigmoid colon and rectal biopsies. Polypharmacy was reviewed for possible medication-induced MC. Ranitidine, donepezil and simvastatin were discontinued. She was started on oral budesonide with improvement in the abdominal and bowel symptoms. Stool frequency and consistency normalised, and the faecal incontinence resolved with treatment. The outcomes were an improved quality of life, reduced functional dependency, reduced carer strain and avoidance of premature transition from her home into a long-term/institutional care setting. We briefly review terminology, basic epidemiology, notable associations, the importance of establishing a diagnosis and some treatment considerations for MC.

KEYWORDS:

continence; drugs: gastrointestinal system; geriatric medicine; inflammatory bowel disease; long term care

PMID:
31175110
DOI:
10.1136/bcr-2018-228092
[Indexed for MEDLINE]
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3.
J Crohns Colitis. 2019 May 27;13(6):764-771. doi: 10.1093/ecco-jcc/jjy224.

Expression Profiling of Inflammatory and Immunological Genes in Collagenous Colitis.

Author information

1
The Department of Pathology, Molecular and Cell-based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Abstract

BACKGROUND:

Collagenous colitis [CC] is a common idiopathic cause of chronic watery diarrhoea. We investigated its pathogenesis by means of gene expression analysis.

METHODS:

We analysed the expression of genes implicated in immunological and inflammatory pathways in paired colonic biopsies of histologically involved and uninvolved mucosa from five patients with histologically patchy CC, in pooled colonic biopsies of eight other patients with diffuse CC, and in pooled biopsies of eight normal controls. Analyses were performed with the Nanostring nCounter system. Expression ratios were generated and confirmed by quantitative reverse transcription PCR.

RESULTS:

CC mucosa was characterized by enhanced expression of nitric oxide synthase 2; of matrix metalloproteinases 3 and 9 and tissue inhibitor of metalloproteinase 1, but not transforming growth factor β1; of mediators of T-helper 1 immunity including interleukins 12A [IL12A], 12B, IL12 receptor B1 and interferon γ; of immune mediators of the leukocyte immunoglobulin-like receptor subfamily B; and of multiple T cell cytokines and their receptors. The mitogen-activated protein kinase signalling pathway was unchanged. There were no increases in IL22, IL22RA2 or tumour necrosis factor α, which are reportedly elevated in chronic inflammatory bowel disease. In four of five patients with patchy CC, similar gene expression profiles were observed in histologically involved and uninvolved mucosa.

CONCLUSIONS:

CC is characterized by altered expression of a limited repertoire of genes involved in nitric oxide synthesis, extracellular matrix remodelling, T-helper 1 immunity and immune modulation. The abnormal gene expression in patchy CC may be expressed in mucosa with and without histological disease manifestations.

KEYWORDS:

Basic science; experimental models and pathophysiology; pathology

PMID:
31131860
PMCID:
PMC6535503
[Available on 2020-05-27]
DOI:
10.1093/ecco-jcc/jjy224
[Indexed for MEDLINE]
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5.
J Clin Nurs. 2019 Oct;28(19-20):3408-3415. doi: 10.1111/jocn.14916. Epub 2019 May 29.

Microscopic colitis: Struggling with an invisible, disabling disease.

Author information

1
Department of Gastroenterology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.

Abstract

BACKGROUND AND AIMS:

Microscopic colitis causes chronic or recurrent nonbloody, watery diarrhoea, which is associated with urgency, faecal incontinence and abdominal pain. The patient's health-related quality of life is often impaired. In microscopic colitis, health-related quality of life has been studied using questionnaires originally constructed and validated for patients with inflammatory bowel disease. The aim of this study was to explore the impact of microscopic colitis on everyday life.

METHODS AND RESULTS:

Inductive, qualitative, semi-structured interviews were performed with 15 persons suffering from microscopic colitis. Content analysis was used to explore the impact of the condition on everyday life. The study followed the consolidated criteria for reporting qualitative research. The qualitative inductive content analysis generated one theme and five subthemes. The theme was "struggling with an invisible, disabling disease." The five subthemes were as follows: physical experience of bowel function; associated symptoms affecting quality of life; impact of the disease on everyday life; disease-related worry; and strategies for managing everyday life.

CONCLUSIONS:

The semi-structured interviews with persons suffering from microscopic colitis provided a wide spectrum of answers to the question of how everyday life is affected. Microscopic colitis can be a disabling life experience, and patients develop different strategies to adapt, cope and regain their previous performance level.

RELEVANCE TO CLINICAL PRACTICE:

There are new and interesting findings in our study that everyday life still remains affected even when patients are in remission. These findings have relevance in clinical practice and may create a better understanding of the patient's symptoms and situation.

KEYWORDS:

inflammatory bowel disease; microscopic colitis; qualitative method; quality of life

PMID:
31090966
DOI:
10.1111/jocn.14916
[Indexed for MEDLINE]
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6.
BMJ Case Rep. 2019 Apr 3;12(4). pii: e226481. doi: 10.1136/bcr-2018-226481.

Topical beclometasone dipropionate in the management of immune checkpoint inhibitor-induced microscopic colitis.

Ibraheim H1,2,3, Green M4, Papa S5,6, Powell N1,2,3.

Author information

1
Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
2
Centre for Inflammation Biology and Cancer Immunology (CIBCI), King's College London, London, UK.
3
Gastroenterology Unit, Royal Marsden Hospital NHS Foundation Trust, London, UK.
4
Department of Histopathology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
5
ImmunoEngineering Group, Cancer Studies, Kings College London, London, UK.
6
Department of Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK.

Abstract

Immune checkpoint inhibitors (ICPis) have revolutionised survival outcomes for cancer patients by bolstering anti-tumour immunity. However, immune activation also occurs in non-cancer tissue, and a significant proportion of patients develop immune-mediated colitis, which can be fatal if not promptly recognised and managed. Diagnosis is often made by inflammation observed during lower gastrointestinal endoscopy. Little is known about microscopic inflammation (histological findings of inflammation in the absence of overt mucosal injury). Management strategies beyond the use of systemic corticosteroids, which incur a high burden of deleterious side effects, have not been extensively explored. We describe the cases of two cancer patients with ICPi-induced colitis who had isolated histoloigical features of colitis in the absence of macroscopic disease. Sustained clinical and histological remission was induced with the topical steroid preparation, beclometasone dipropionate (Clipper), with no adverse effects.

KEYWORDS:

immunology; inflammatory bowel disease; oncology

PMID:
30948391
DOI:
10.1136/bcr-2018-226481
[Indexed for MEDLINE]
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7.
Medicine (Baltimore). 2019 Mar;98(11):e14870. doi: 10.1097/MD.0000000000014870.

Three case reports of collagenous gastritis in children: Lessons for an endoscopic and histologic approach to mucosal nodularity of the stomach.

Author information

1
Department of Pediatrics, Pusan National University School of Medicine, Pusan National University Children's Hospital, Yangsan.
2
Department of Anatomy and cell biology, Kangwon National University School of Medicine.
3
Department of Anatomic Pathology, Kangwon National University School of Medicine.
4
Department of Pathology, Kangwon National University Hospital.
5
Department of Pediatrics, Kangwon National University School of Medicine, Chuncheon, Republic of Korea.

Abstract

RATIONALE:

Collagenous gastritis (CG) is a rare form of chronic gastritis defined histologically by a thickened subepithelial collageneous band in the lamina propria. However, the clinical features and endoscopic findings of CG have not been clearly established in the pediatric population.

PRESENTING CONCERNS:

We report the cases of 3 children who presented with intractable anemia and minimal or no gastrointestinal (GI) symptoms and were followed up without definitive diagnosis determination even through diagnostic endoscopic evaluations.

DIAGNOSES:

On repeated endoscopic examination, we determined thickened subepithelial collagen band, confirmed by Masson trichrome staining using targeted biopsies of the intervening mucosa between the prominent nodular lesions.

INTERVENTIONS:

Under the diagnosis of CG, a course of steroid was administrated in 1 patient, while all patients continued oral iron replacement therapy.

OUTCOMES:

All 3 patients remained asymptomatic and their anemia was alleviated with continued administration of oral iron.

MAIN LESSONS:

We recommend early endoscopic evaluation for patients with unexplained anemia, emphasizing a high index of suspicion for CG, despite the absence of definitive GI symptoms. Targeted gastric biopsies should be performed in the depressed mucosa surrounding the nodules, as well as the nodules themselves, to confirm CG, when presented with nodular gastric mucosa in endoscopy.

PMID:
30882690
PMCID:
PMC6426568
DOI:
10.1097/MD.0000000000014870
[Indexed for MEDLINE]
Free PMC Article
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8.
Rev Gastroenterol Peru. 2018 Oct-Dec;38(4):345-348.

[Neuroendocrine hiperplasia in linfocitic and ulcerative colitis].

[Article in Spanish]

Author information

1
Servicio Patología, Hospital Nacional Daniel Alcides Carrión. Callao, Perú; Universidad Nacional Mayor de San Marcos. Lima, Perú.
2
Servicio Gastroenterología, Hospital Nacional Daniel Alcides Carrión. Callao, Perú; Universidad Nacional Mayor de San Marcos. Lima, Perú; Universidad Peruana Cayetano Heredia. Lima, Perú.
3
Servicio Patología, Hospital Nacional Daniel Alcides Carrión. Callao, Perú.

Abstract

INTRODUCTION:

Some authors have found increase of neuroendocrine cells in microscopic colitis and ulcerative colitis.

OBJECTIVE:

The aim of this study is to evaluate the presence of neuroendocrine cells in ulcerative colitis and lymphocytic colitis and collagenous colitis.

MATERIALS AND METHODS:

Immunohistochemistry was performed to identify neuroendocrine cells through marker chromogranin A (CgA). The study included 10 cases of each diagnosis of Lymphocytic colitis, collagenous colitis and ulcerative colitis.

RESULTS:

There was statistically significant difference in the count of neuroendocrine cells, between lymphocytic colitis and control (p=0.019104), and between ulcerative colitis and controls (p=0.0077). In collagenous colitis there was an increase in neuroendocrine cells but we failed to find statistical differences.

CONCLUSION:

We could observe neuroendocrine cell hyperplasia in lymphocytic colitis and ulcerative colitis compared with controls, which confirm previous studies.

PMID:
30860505
[Indexed for MEDLINE]
9.
Med Hypotheses. 2019 Feb;123:90-94. doi: 10.1016/j.mehy.2019.01.004. Epub 2019 Jan 7.

Collagenous colitis development occurs after long standing mucosal healing in IBD with TNF-α inhibitors, and could be due to exaggerated healing response from excess TNF-α inhibition.

Author information

1
Section of Gastroenterology, Hepatology & Nutrition, Rush University Medical Center, Chicago, IL, United States.
2
Section of Gastroenterology, Hepatology & Nutrition, Rush University Medical Center, Chicago, IL, United States. Electronic address: ece_mutlu@rush.edu.

Abstract

Collagenous colitis is a relatively rare disorder affecting mainly middle-aged women where they present with chronic non-bloody diarrhea. Both with lymphocytic colitis they compose microscopic colitis. The exact cause of collagenous colitis is still unknown however; many potential pathophysiologic mechanisms have been proposed but no convincing mechanism has been identified. Collagenous colitis has been linked to medications mainly NSAIDs, SSRIs, and PPIs. It is also believed that collagenous colitis is autoimmune disease and there are weak believe it could have some genetic inheritance. We reported before two cases of collagenous colitis developed in patients with Crohn's disease and ulcerative colitis while they were in complete mucosal remission after being treated with tumor necrosis factors-α inhibitors. In this article we will try to explain how collagenous colitis can develop in patients with inflammatory bowel disease especially those on tumor necrosis factors-α inhibitors.

PMID:
30696605
DOI:
10.1016/j.mehy.2019.01.004
[Indexed for MEDLINE]
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10.
Am J Case Rep. 2019 Jan 26;20:111-116. doi: 10.12659/AJCR.913207.

Olmesartan Associated Enteropathy: A Rare Underdiagnosed Cause of Diarrhea and Weight Loss.

Author information

1
Department of Internal Medicine, North East Ohio Medical University, Canton Medical Education Foundation, Canton, OH, USA.
2
Department of Internal Medicine, North East Ohio Medical University, Rootstown, OH, USA.

Abstract

BACKGROUND Olmesartan, an angiotensin receptor blockade class of antihypertensive medication has recently been associated with a seronegative sprue like enteropathy. Patients typically present with diarrhea and weight loss often prompting exhaustive diagnostic workup. Discontinuation of the drug leads to dramatic recovery and hence, physicians need to be aware of olmesartan associated enteropathy (OAE) in order to avoid unnecessary testing. CASE REPORT A 59-year-old Caucasian male was admitted to the hospital with complaints of intractable diarrhea, vomiting and considerable weight loss. Medical history was notable for hypertension being treated with olmesartan. Workup for all potential infectious causes and celiac disease was negative. Eventually, a colonoscopy was performed due to his persistent symptoms and biopsy revealed lymphocytic colitis. An upper endoscopy was also performed, and histopathology of the duodenum revealed total villous blunting. In light of negative serology for celiac disease and after a detailed review of the patient's medications, the possibility of olmesartan induced enteropathy was considered. Olmesartan was stopped and his symptoms resolved. A follow-up endoscopy done a few months later showed normal small bowel mucosa. CONCLUSIONS This case demonstrates the need for a thorough medication review by healthcare providers especially after a full workup for the patient's symptoms has already been performed. It also reiterates that having an awareness of rare side effects of common medications mitigates the need for extensive diagnostic testing.

PMID:
30683835
PMCID:
PMC6364444
DOI:
10.12659/AJCR.913207
[Indexed for MEDLINE]
Free PMC Article
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12.
BMC Gastroenterol. 2019 Jan 5;19(1):1. doi: 10.1186/s12876-018-0926-4.

Cancer risk in microscopic colitis: a retrospective cohort study.

Author information

1
Division of Gastroenterology, Tufts Medical Center, Boston, MA, 02111, USA.
2
Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, 02114, USA.
3
Harvard Medical School, Boston, MA, 02115, USA.
4
Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, 02114, USA. aananthakrishnan@mgh.harvard.edu.
5
Harvard Medical School, Boston, MA, 02115, USA. aananthakrishnan@mgh.harvard.edu.

Abstract

BACKGROUND:

The long-term natural history of microscopic colitis (MC) (collagenous colitis (CC), lymphocytic colitis (LC)), traditionally considered relapsing but non-progressive diseases, is poorly defined. Whether persistent histologic inflammation in such diseases is associated with an increased risk of colorectal neoplasia (CRN) or extracolonic cancers has not been robustly established.

METHODS:

This retrospective cohort included diagnosed with MC at a referral center. Rates of CRN and extracolonic cancer were compared to patients undergoing screening colonoscopy (n = 306) and to the United States population using data from the Surveillance, Epidemiology, and End-Results (SEER) program. Standardized incidence ratios (SIR) and 95% confidence intervals were calculated and multivariable regression models used to identify the effect of MC diagnosis and severity on cancer risk.

RESULTS:

Our study included 221 patients with microscopic colitis (112 CC, 109 LC) among whom 77% were women. Compared to the colonoscopy control population, MC was associated with similar odds of tubular adenoma (Odds ratio (OR) 1.07, 95% CI 0.69-1.66) or villous adenoma (OR 1.26, 95% CI 0.17-9.42). Compared to patients with a single episode of MC, those with 2 or more episodes had similar risk of colon cancer (OR 0.83, 95% CI 0.20-3.39) or tubular adenoma (OR 1.49 95% CI 0.83-2.67). We also identified no statistical increase in the rates of cancer in the MC population compared to US-SEER data.

CONCLUSION:

Microscopic colitis was not associated with increased risk of CRN and extracolonic cancers when compared to controls undergoing colonoscopy or the US SEER population.

KEYWORDS:

Adenoma; Cancer; Colorectal neoplasia; Lymphocytic colitis; Microscopic colitis

PMID:
30611218
PMCID:
PMC6321729
DOI:
10.1186/s12876-018-0926-4
[Indexed for MEDLINE]
Free PMC Article
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13.
Scand J Gastroenterol. 2018 Dec;53(12):1469-1475. doi: 10.1080/00365521.2018.1543446. Epub 2019 Jan 2.

Validating microscopic colitis (MC) in Swedish pathology registers.

Author information

1
a Department of Paediatrics , Örebro University Hospital , Örebro , Sweden.
2
b Department of Medical Epidemiology and Biostatistics , Karolinska Institutet , Stockholm , Sweden.
3
c Department of Medicine Solna, Clinical Epidemiology Unit , Karolinska Institutet , Stockholm , Sweden.
4
d Sachs' Children and Youth Hospital , Stockholm South General Hospital , Stockholm , Sweden.
5
e Department of Clinical and Experimental Medicine , Linköping University , Linköping, Sweden.
6
f Department of Surgery , Linköping University Hospital , Linköping, Sweden.
7
g Department of Gastroenterology, Faculty of Medicine and Health , Örebro University , Örebro, Sweden.
8
h Gastroenterology Unit , Crohn's and Colitis Center, Massachusetts General Hospital, Harvard Medical School , Boston , MA , USA.
9
i Department of Gastroenterology , Linköping University Hospital , Linköping, Sweden.
10
j Division of Epidemiology and Public Health School of Medicine , University of Nottingham , Nottingham , UK.
11
k Department of Medicine, College of Physicians and Surgeons , Columbia University , New York , NY , USA.

Abstract

OBJECTIVE:

Microscopic colitis (MC), encompassing collagenous colitis (CC) and lymphocytic colitis (LC), is a diagnosis which relies on histopathologic criteria. This report examines the validity of having a diagnosis of MC in Swedish pathology registers.

METHODS:

We reviewed patient charts from 215 randomly selected individuals from 15 pathology departments in five healthcare regions in Sweden with a relevant histopathology code for MC on colon biopsies. Information on clinical symptoms and laboratory data were obtained from medical chart review. We obtained sufficient data on 211 individuals for calculating positive predictive values (PPVs) for MC.

RESULTS:

In total, 200/211 patients with a histopathology diagnosis of MC were confirmed as also having a clinical diagnosis of MC after chart review, yielding a PPV of 95% (95%CI =91-97%). The PPV for CC was 95% (95%CI =87-98%) and 85% for LC (95%CI =78-90%). The median age at biopsy was 67 years (range 17-90 years), and 72% (n = 154) were women. The most common symptoms in patients with MC histopathology were diarrhea (96% of patients), weight loss (24%) and abdominal pain (13%). Four percent (4/111) of patients with available data on stool culture were positive for gastrointestinal pathogens (none had Clostridium difficile). In 81 patients with available celiac serology, five (6%) were positive. Twenty-six percent of all patients had at least one other autoimmune disease, the most frequent being hypothyroidism (8%) and celiac disease (6%).

CONCLUSIONS:

This study found a high validity for MC as recorded in Swedish pathology registers.

KEYWORDS:

Microscopic colitis; collagenous colitis; histopathology; lymphocytic colitis; validation

PMID:
30600733
DOI:
10.1080/00365521.2018.1543446
[Indexed for MEDLINE]
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14.
JAAPA. 2019 Jan;32(1):52-53. doi: 10.1097/01.JAA.0000550298.75971.2b.

Why does this patient have chronic diarrhea?

Author information

1
At the time this article was written, Victoria M. Verkest was a student in the PA program at Marietta (Ohio) College. She now practices at Pinnacle Dermatology in Birmingham, Mich. Patricia G. Martin is a retired PA and assistant professor in the PA program at Marietta College. Rajiv Agrawal practices family medicine in Shelby Township and St. Clair Shores, Mich., and is an associate clinical instructor of family medicine in the PA program at Marietta College. The authors have no potential conflicts of interest, financial or otherwise to disclose.
[Indexed for MEDLINE]
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15.
Minerva Gastroenterol Dietol. 2019 Mar;65(1):53-62. doi: 10.23736/S1121-421X.18.02539-4. Epub 2018 Nov 21.

Microscopic colitis: a narrative review with clinical approach.

Author information

1
Department of Gastroenterology, University of Turin, Turin, Italy.
2
Section of Physiopathology and Manometry, Unit of Gastroenterology and Endoscopy, Cardinal Massaja Hospital, Asti, Italy.
3
Unit of Gastroenterology, Molinette-SGAS Hospital, Turin, Italy - rinaldo_pellican@hotmail.com.

Abstract

Microscopic colitis (MC) is diagnosed in presence of microscopic alterations of colonic mucosa, in patients without macroscopic lesions who referred for chronic diarrhea. The two types of MC are lymphocytic colitis (LC) and collagenous colitis (CC), but it is unclear whether these are the different expression of one unique disease or if they are distinct conditions. Today, although MC represents a consistent health problem, being responsible for a large part of gastroenterological consultations for diarrhea, it remains often underestimated. The detailed pathogenesis of MC has not been determined yet. Probably, it is the result of an interaction between individual, environmental and genetic factors. The most relevant risk factor for the development of MC is the use of certain drugs (such as non-steroidal anti-inflammatory drugs [NSAIDs], proton pump inhibitors [PPIs], selective serotonin reuptake inhibitors, beta-blockers, statins). Smoking is another relevant factor reported as associated with the development of MC. Diagnosis needs the execution of a colonoscopy in patients complaining about chronic diarrhea and abdominal pain. The crucial role is played by histology: MC is characterized by the presence of colonic mucosal lymphocytic infiltrate, with intraepithelial lymphocytes ≥20 per 100 enteric surface cells, in CC there is a typical subepithelial collagen layer, whose thickness is ≥10 μm. We carried out a review of the current literature to rule out what is new on epidemiology, diagnosis and therapy of MC.

PMID:
30486642
DOI:
10.23736/S1121-421X.18.02539-4
[Indexed for MEDLINE]
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16.
Gastroenterology. 2018 Dec;155(6):1679-1681. doi: 10.1053/j.gastro.2018.11.007. Epub 2018 Nov 9.

Do Sex Hormones Cause, or Are They Only Associated With, Microscopic Colitis?

Author information

1
Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee.
2
Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center and Vanderbilt-Ingram Cancer Center and VA Tennessee Valley Healthcare System, Nashville, Tennessee. Electronic address: reid.ness@vumc.org.
PMID:
30419213
DOI:
10.1053/j.gastro.2018.11.007
[Indexed for MEDLINE]
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17.
Praxis (Bern 1994). 2018;107(22):1195-1199. doi: 10.1024/1661-8157/a003099.

[Microscopic Colitis].

[Article in German; Abstract available in German from the publisher]

Author information

1
1 Klinik für Allgemein-, Viszeral- und Gefässchirurgie, Kantonsspital Baden.
2
2 Zentrum für Gastroenterologie Hepatologie, Zürich-Altstetten.

Abstract

Microscopic colitis (MC) is still an underestimated cause of chronic, non-bloody watery diarrhea. It is typically manifested in elderly patients with a female predominance. The incidence of microscopic colitis has been increasing. The aetiology and pathophysiology remain unclear. Conditions associated with it include autoimmune diseases. There may be a genetic predisposition, as familial cases have been described. As implicated by the name microscopic colitis, the diagnosis is found by histological examination. There are mainly two subtypes, the lymphocytic colitis (LC) and the collagenous colitis (CC). Even if the condition's long-term course is benign, a chronic recurrent course of the symptoms is frequent. Due to the symptoms, there is an impairment of patient's health-related quality of life. A correct diagnosis and therapy is therefore mandatory. The aim of this paper is to create awareness for microscopic colitis.

KEYWORDS:

Autoimmunerkrankung; Colite microscopique; Lebensqualität; Microscopic colitis; Mikroskopische Kolitis; autoimmune disease; colite collagène; colite lymphocytaire; collagenous colitis; kollagene Kolitis; lymphocytic colitis; lymphozytäre Kolitis; maladie auto-immune; quality of life; qualité de vie

Comment in

PMID:
30376775
DOI:
10.1024/1661-8157/a003099
[Indexed for MEDLINE]
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18.
Actas Esp Psiquiatr. 2018 Sep;46(5):200-4. Epub 2018 Sep 1.

Antidepressants and its relationship with microscopic colitis.

Author information

1
Psychiatry department, Ramón y Cajal University Hospital, Madrid.
2
Gastroenterology and Hepatology department, Ramón y Cajal University Hospital, Madrid.
PMID:
30338777
[Indexed for MEDLINE]
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19.
J Crohns Colitis. 2019 Mar 26;13(3):337-340. doi: 10.1093/ecco-jcc/jjy169.

Vedolizumab in Refractory Microscopic Colitis: An International Case Series.

Author information

1
Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Herestraat, Leuven, Belgium.
2
Division of Gastroenterology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
3
Gastro-entérologie La Source-Beaulieu, Lausanne, Switzerland.
4
Division of Gastroenterology, Department of Medicine, Western University, London, Ontario, Canada.
5
Department of Pathology, University Hospitals Leuven, KU Leuven, Herestraat, Leuven, Belgium.
6
Department of Gastroenterology, AZA Herentals, Herentals, Belgium.

Abstract

BACKGROUND:

Evidence for second-line therapy in patients with microscopic colitis [MC] failing budesonide is scarce, although anti-tumour necrosis factors [anti-TNFs], methotrexate and azathioprine have been reported to be effective in small cohort studies. Vedolizumab, a monoclonal antibody targeting α4β7-integrin, prevents homing of T-cells to the gut. We evaluated clinical remission with vedolizumab in budesonide-refractory MC patients.

METHODS:

We solicited gastroenterologists in Europe and Canada for cases of MC treated with vedolizumab. Vedolizumab 300 mg IV was administered at weeks 0, 2 and 6, and then every 8 weeks. Clinical remission and histological remission were defined as less than three stools per day and normalization of histology, respectively, after induction treatment.

RESULTS:

Eleven cases were retrieved (nine females, lymphocytic colitis [LC] n = 5, collagenous colitis [CC] n = 6). Median [interquartile range] disease duration at vedolizumab initiation was 51 [29-70] months. Nine of 11 patients had failed one immunosuppressant and ten of 11 at least one anti-TNF agent. After three infusions of vedolizumab, clinical remission was observed in 5/11 patients [two LC and three CC] of whom three remained well with maintenance therapy [median duration of 13 months]. Biopsies were obtained from 9/11 patients. Histological remission was observed in 3/4 patients with clinical remission [2/3 CC, 1/1 LC] and 0/5 patients without clinical improvement.

CONCLUSION:

In a series of highly refractory MC patients, vedolizumab induced clinical remission in 5/11 subjects, of whom 75% showed normalized histology. Larger randomized trials are needed to assess the efficacy of vedolizumab in patients with MC.

KEYWORDS:

microscopic colitis; refractory; treatment outcome; vedolizumab

PMID:
30329034
DOI:
10.1093/ecco-jcc/jjy169
[Indexed for MEDLINE]
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20.
Dig Dis Sci. 2019 Feb;64(2):432-438. doi: 10.1007/s10620-018-5313-z. Epub 2018 Oct 15.

Proinflammatory Sulfur-Reducing Bacteria Are More Abundant in Colonic Biopsies of Patients with Microscopic Colitis Compared to Healthy Controls.

Author information

1
Department of Medicine, Baylor College of Medicine, 2002 Holcombe Blvd MCL-111D, Houston, TX, 77030, USA.
2
Department of Pathology, Baylor College of Medicine, Houston, TX, USA.
3
Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
4
Department of Medicine, Baylor College of Medicine, 2002 Holcombe Blvd MCL-111D, Houston, TX, 77030, USA. rajeshs@bcm.edu.
5
Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA. rajeshs@bcm.edu.

Abstract

BACKGROUND:

Microscopic colitis (MC), a subtype of inflammatory bowel disease, is a chronic condition of unknown etiology. Recent evidence has linked MC with intriguing changes in the stool microbiota, which may be linked to disease pathogenesis. The composition of the mucosal microbiome in patients with MC remains unclear.

METHODS:

We performed a cross-sectional study comparing colonic tissue samples from patients with MC to those of healthy controls at the Michael E. DeBakey VA Medical Center. We included adults older than 18 who underwent a colonoscopy with biopsies to evaluate chronic diarrhea. Cases were defined by histology consistent with MC and controls by the absence of histologic disease. We conducted structured chart review to exclude other gastrointestinal diseases and obtain demographic (age, sex, race) and clinical (duration of symptoms and concurrent medications) information for cases and controls. We extracted bacterial DNA from formalin-fixed paraffin-embedded tissue samples and sequenced the v4 region of the 16S rRNA gene. Operational taxonomic unit (OTU) clustering was performed using UPARSE, and OTUs were assigned using the SILVA database. Statistical analysis was performed in QIIME and LEfSe. Comparisons with FDR-adjusted p values of less than 0.05 were considered statistically significant.

RESULTS:

We included 20 MC patients and 20 controls with mean ages of 62 and 54, respectively. Most cases were White (95%), 60% had symptoms for greater than 12 months, and 50% were taking PPIs and NSAIDs at the time of their diagnosis. Compared to controls, MC patients had a significant increase in the proinflammatory sulfur-reducing bacterial family Desulfovibrionales. The Coriobacteriaceae family, abundant in the healthy gut, was significantly decreased in MC cases. There was also an increase in the genus Actinomyces in MC patients on PPI and an increase in the class Bacilli among those taking NSAIDs.

DISCUSSION:

Patients with MC have an increase in the proinflammatory family Desulfovibrionales. Actinomyces and Bacilli were associated with medications (PPI and NSAID) known to increase the risk of MC. Our findings may have important implications for understanding the pathogenesis of MC.

KEYWORDS:

Diarrhea; Microbiome; Microscopic colitis; Sulfur-reducing bacteria

PMID:
30324555
DOI:
10.1007/s10620-018-5313-z
[Indexed for MEDLINE]
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