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home - Colon - Various Colitides - Microscopic Colitis Written by Dr Sebastian Zeki

Microscopic Colitis

Colitis-microscopic colitis (=10% of diarrhoea referrals) CollagenousMore common in females.Incidence 2.5/100,000/year. Lymphocytic colitis More limited in course. The incidence is 4/100,000/yr. It has a more favourable course. Diarrhoea subsides in 93 %. Histologic normalization in82 %. Lymphocytic and collagenous colitis (microscopic colitis)Other variants of microscopic colitis:Pericrypt eosinophilic enterocolitis- associated with a systemic connective tissue diseaseColitis associated with increased mast cells in the colonic mucosaCollagenous gastritis has histologic features resembling the other collagenous enterocolitides but is very rare. Labs: Non-specific- may get slight anaemia/ inc ESR/ autoantibodies in 50% (RF,ANA,AMA,ANCA) Both happen in 50's to 60's Most biopsies can be taken within range of a flexible sig. Presentation: -Intermittent watery stools > 1 month. Up to 2L/day. 4-9 stools/d -Can be nocturnal to distinguish from IBS -Can be associated with abdominal cramps, weight loss -Can be associated with EIM’s , eg arthralgia, arthritis, or uveitis Related but one doesnt become the other Myofibr-blastic cells Procollagen I and metallo-proteinase inhibitor (TIMP-1) Overexpression Over expression of Transforming growth factor (TGF) beta-1 and vascular endothelial growth factor (VEGF) Reduced fibrolysis Type VI collagen and for the glycoprotein tenascin Bacterial toxin may be influentialClostridium difficile? Synchronous collagenous and pseudomembranous colitis can be seen.Yersinia sp.? Helicobacter pylori -Resolution of collagenous colitis has been described following treatment. NaCl Cl- No resolution Management options:Stop relevant drugs/Rule out coeliac.Loperamide for symptomatic relief.Budesonide- 6 weeks.Aminosalicylate or sulfasalazine.Short trial of cholestyramine (4 g four times per day).Corticosteroids.Metronidazole (400 mg three times daily)and, for severe symptomatic diarrhoea.Octreotide (50 to 100 mcg every eight hours s/c), methotrexate, azathioprine, 6-MP, and verapamil can all be tried. No resolution No resolution No resolution No resolution Alternative Treatments:Bismuth subsalicylate. The probiotic E. coli strain Nissle.Boswellia serrata extract (created from resins of the Boswellia serrata tree) which improves symptoms but not histology.Surgery — Sometimes diversion used with good effect. No resolution Histological Features Right sided biopsies are best, rectosigmoid the worst. There are increased intraepithelial lymphocytes (>5IEL/100 epithelial cells) in lymphocytic colitis. Collagenous band of >10 microns distinguishes in collagenous colitis. -Increased chronic inflammation in lamina propria and flattened epith - lial cells exist in both. Autoimmune disorders twice as common in collagenous than lymphocytic -Rheumatological conditions;Thyroid disease;DM;Lupus -Sicca syndrome;Atrophic gastritis;PBC;HLA-A1-lymphocytic -HLA-A2-collagenous;Coeliac (20% of microscopic) Drug association -NSAID's- up to 6 years prior to presentation;Ranitidine; Lansoprazole,omeprazole,esomeprazole;Ticlodipine;Simvastatin;S ertraline;Acarbose Mechanism of diarrhea :Inflammation with decreased NaCl absorption and active Cl secretion.The subepithelial collagenous band acting as a diffusion barrier is a cofactor.Tight junction molecules also down-graded Pathogenesis (Av. remission 12days)Relapse common once budesonide stopped No resolution Written by Dr Sebastian Zeki Associated conditions

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