Sequential clinical and histopathological changes in collagenous and lymphocytic colitis over time

Abstract

We conducted this retrospective study to evaluate the relationship between symptoms, histological findings, and treatment of collagenous (CC) and lymphocytic colitis (LC). We identified 19 CC and 12 LC patients having multiple colonoscopic procedures with colonic biopsies during their course of illness. A detailed histological review of all biopsies was performed. Clinical history, including symptoms and medications, was obtained in 25 of the 31 patients and was correlated with their histological findings. In all, 25% of the CC patients and 50% of the LC patients who had biopsies prior to their definitive diagnosis had the pathognomonic histological features on their prior biopsies to some extent (but were not recognized by the pathologists); however, these features were more pronounced on the biopsies from the procedure that established the diagnosis. Nonetheless, 10 of 12 such patients with clinical data available had symptoms and were being treated at the time of prior biopsies. Assessment of the relationship among histological, clinical and therapeutic data showed no association between symptoms or histological findings and treatment with any medication. In summary, in this sample of CC and LC patients, symptoms often precede fully developed histological features. No change in symptoms or histological findings was found to be associated with medication.

Clinical significance of colonic intraepithelial lymphocytosis in a pediatric population

“…6,21 We are aware that changes suggestive of idiopathic inflammatory bowel disease, including crypt architecture distortion, acute crypt inflammation, and Paneth cell metaplasia have been described as part of the histologic spectrum of lymphocytic colitis in the adult population. 22,23 However, all of the patients with these changes, in addition to colonic intraepithelial lymphocytosis, proved to have idiopathic inflammatory bowel disease within our follow-up period.…”

Lymphocytic Follicles and Aggregates Are a Determinant of Mucosal Damage and Duration of Diarrhea

“…Ayata et al, 17 in a review of 79 LC and 71 CC cases, found no evidence of basal lymphoid aggregates, but others suggest that lymphoid follicles and aggregates are an early event in the course of CC and LC. 18 Although it would be interesting to hypothesize that our observation could be better placed in the MC spectrum, our patients differ clinically by (1) slightly male predominance; (2) a younger mean age; (3) and lack of association with autoimmune disease and nonsteroidal anti-inflammatory drug intake. In any case, this should be placed in the limiting context of the relative small sample size of this study.…”

“…The following histologic parameters were examined according to previous studies [14][15][16][17][18][19][20][21][22][23] :…”

“…The number of lymphoid follicles and aggregates in each biopsy. 17,18 Lymphoid follicles were defined as aggregates of lymphocytes with a germinal center. A lymphoid aggregate was defined as accumulation of lymphocytes and plasma cells without a germinal center.…”

The Role of T-Cell Subsets in Chronic Inflammation in Celiac Disease and Inflammatory Bowel Disease Patients: More Common Mechanisms or More Differences?

“…It remains unclear whether local expansion or infiltration is responsible for an increase in T cells [71,139]. Absent correlation between the severity of the clinical symptoms and IEL numbers or thickness of the collagen layer as characteristic features of the two entities points to a dominance of the inflammatory infiltrates in the mucosal lamina propria [140]. The LPL composition strongly depends on the disease state and the exact origin of the samples [141], which might help to explain differences in the T-cell compartment found in independent surveys.…”