Collagenous colitis: Recent developments

Abstract

SUMMARY
Collagenous colitis and lymphocytic colitis are two chronic
inflammatory conditions, involving the large bowel. These
two interesting entities, are usually referred to under the
general term microscopic colitis. Collagenous colitis is
characterized by watery diarrhea, abdominal bloating and
mild loss of weight. The true incidence is unknown. However,
it has been estimated that it is unlikely to exceed one case
per 100000 population. The etiology is unknown, although
the use of non-steroidal anti-inflammatory drugs and
lansoprazole, as well as infection by Yersinia enterocolitica
have been implicated in the pathogenesis of the disease.
The role of activated eosinophils seems to be quite
important. Diagnosis requires the histological detection of
a thick subepithelial collagen band on large bowel mucosa
biopsies. Treatment includes the administration of
mesalamine, corticosteroids, budesonide, cholestyramine,
as well as methotrexate, pendoxyphylline and octeotride.
Surgery is reserved for severe cases. The course of the
disease seems to be quite benign. Although most patients
relapse after treatment cessation, most are asymptomatic
for a long period of time after the establishment of
diagnosis. Progression to ulcerative colitis occurs although
in only a small percentage of patients. Fortunately no
association with intestinal or extraintestinal cancers has
been found.
Key words: Collagenous colitis, Inflammatory bowel
disease, Microscopic colitis, Lymphocytic colitis