Macroscopic findings in collagenous colitis: a multi-center, retrospective, observational cohort study

Anastasios Koulaouzidis; Diana E. Yung; Artur Nemeth; Klas SjÃ¶berg; Andry Giannakou; Raheel Qureshi; Leonidas Bartzis; Morna McNeill; Gabriele Wurm Johansson; Alfredo J. Lucendo; Paul Fineron; Ken C. Trimble; Athar Saeed; John N. Plevris; Ervin Toth

Authors Anastasios Koulaouzidis, Diana E. Yung, Artur Nemeth, Klas SjÃ¶berg, Andry Giannakou, Raheel Qureshi, Leonidas Bartzis, Morna McNeill, Gabriele Wurm Johansson, Alfredo J. Lucendo, Paul Fineron, Ken C. Trimble, Athar Saeed, John N. Plevris, Ervin Toth.

Abstract

Background Collagenous colitis (CC) is by definition a histological diagnosis. However, colonoscopy often reveals characteristic endoscopic findings. The aim of this study was to evaluate the frequency and type of endoscopic findings in patients diagnosed with CC in 4 participating centers.

Methods This was a retrospective study; the databases of 2 university hospitals in Edinburgh (Scotland) and MalmÃ¶ (Sweden), and 2 district general hospitals in Tomelloso (Spain) and Gateshead (England) were interrogated for patients diagnosed with CC between May 2008 and August 2013. Endoscopy reports and images were retrieved and reviewed; data on lesions, sedation, bowel preparation and endoscopist experience were abstracted. Categorical data are reported as meanÂ±SD. Fischer's exact, chi-square and t (unpaired) tests were used to compare datasets. A two-tailed P-value of <0.05 was considered statistically significant.

Results 607 patients (149 male, mean age 66.9Â±12.25 years) were diagnosed with CC. A total of 108/607 (17.8%) patients had one or more suggestive endoscopy findings: i.e., mucosal erythema/edema, 91/607 (15%); linear colonic mucosal defects, 12/607 (2%); or mucosal scarring, 5/607 (0.82%). For colonic mucosa erythema, there was no difference in the odds of finding erythema with the use of different bowel preparation methods (P=0.997). For colonic mucosal defects there was some evidence (P=0.005) that patients colonoscoped by experienced endoscopists had 87% less odds of developing such defects. Moreover, there was evidence that analgesia reduced the odds of developing mucosal defects by 84%.

Conclusion A significant minority of patients with CC have endoscopic findings in colonoscopy. The description of such findings appears to be related to the endoscopist's experience.

Keywords Microscopic colitis, colonoscopy, macroscopic findings, endoscopist training, observational study

Ann Gastroenterol 2017; 30 (3): 309-314