Collagenous colitis.

Abstract

Clinical and pathological aspects of six patients with collagenous colitis are presented. These patients have been observed for between four and 15 years and the evolution of the condition is documented in three (cases 1, 3 and 5). Management and possible pathogenetic mechanisms of this enigmatic condition are discussed. The term collagenous colitis was introduced by Lindstrom' in 1976 to describe the microscopical changes seen in the rectal biopsies of a patient with longstanding watery diarrhoea. Since then over 20 isolated cases have been reported mainly from continental Europe.220 The clinical and pathological descriptions have all been similar. The patients are predominantly middle aged women, essentially well apart from watery diarrhoea and abdominal pain. Clinical examination, including sigmoidoscopy, is usually unremarkable as are laboratory investigations. The condition is unresponsive to conventional treatment used in inflammatory bowel disease. The cause of the abnormally thick band of collagen underlying the colonic epithelium is speculative as is its relationship to the diarrhoea, but it is tempting to attribute the latter to the former. Some have proposed2 10 12 14 19 that the pathogenesis lies in the abnormal differentiation of the pericryptal fibroblastic sheath,21 but the primary aetiology is obscure. The paucity of published cases implies this condition to be exceptionally rare. One of us has seen and followed six new cases in the past 13 years in the course of general gastroenterological practice, which suggests collagenous colitis to be commoner than generally supposed. We report the clinical and pathological aspects of these six patients.

Budesonide in the Treatment of Collagenous Colitis

“…This colitis is a clinicopathological entity of unknown etiology, characterized by watery diarrhea and normal or subnormal endoscopic appearance at colonoscopy [2,3]. The diagnosis of collagenous colitis is established by colonic biopsies showing a thickened continuous or patchy subepithelial collagen layer associated with a nonspecific chronic inflammatory infiltrate of the lamina propria and to an increase in the number of intraepithelial lymphocytes [2,4].…”

Collagenous, microscopic and lymphocytic colitis. An evolving concept

“…Rare cases of lymphocytic colitis with apparent progression to collagenous colitis have been reported [26,30,39,52]. This is still a very difficult and controversial area.…”

“…The John Hopkins group further argued that, with the exception of the subepithelial collagen band, microscopic colitis ressembled collagenous colitis histologically, because both showed injury to the surface epithelium, particularly increased numbers of intraepithelial lymphocytes, and excess of chronic inflammatory cells in the lamina propria. Another argument of the John Hopkins group was that there were a few cases in the literature in which apparent progression from microscopic colitis to collagenous colitis had been noted [30,40,52].…”

Nonspecific radiographic abnormalities in collagenous colitis

“…Biopsy of the colonic mucosa demonstrates abnormal thickening of the subepithelial collagen layer along with a chronic inflammatory cell infiltrate [3][4][5]. It was initially reported by Lindstrom in 1976 [6], and since that time there have been numerous reports in the clinical literature describing and further defining the clinicopathologic aspects of this disease.…”