|
1
|
Marlicz W, Skonieczna-Żydecka K, Yung DE, Loniewski I, Koulaouzidis A. Endoscopic findings and colonic perforation in microscopic colitis: A systematic review. Dig Liver Dis 2017; 49:1073-1085. [PMID: 28847471 DOI: 10.1016/j.dld.2017.07.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 07/23/2017] [Accepted: 07/25/2017] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Microscopic colitis (MC) is a clinical syndrome of severe watery diarrhea with few or no endoscopic abnormalities. The incidence of MC is reported similar to that of other inflammatory bowel diseases. The need for histological confirmation of MC frequently guides reimbursement health policies. With the advent of high-definition (HD) coloscopes, the incidence of reporting distinct endoscopic findings in MC has risen. This has the potential to improve timely diagnosis and cost-effective MC management and diminish the workload and costs of busy modern endoscopy units. METHODS Publications on distinct endoscopic findings in MC available until March 31st, 2017 were searched systematically (electronic and manual) in PubMed database. The following search terms/descriptors were used: collagenous colitis (CC) OR lymphocytic colitis (LC) AND endoscopy, colonoscopy, findings, macroscopic, erythema, mucosa, vasculature, scars, lacerations, fractures. An additional search for MC AND perforation was made. RESULTS Eighty (n=80) articles, predominantly single case reports (n=49), were found. Overall, 1582 (1159F; 61.6±14.1 years) patients (pts) with MC and endoscopic findings were reported. The majority of articles (n=62) were on CC (pts 756; 77.5% females). We identified 16 papers comprising 779 pts (69.2% females) with LC and 7 articles describing 47 pts (72.3% females) diagnosed as MC. The youngest patient was 10 and the oldest a 97-year-old. Aside diarrhea, symptoms included abdominal pain, weight loss, bloating, flatulence, edema and others. In the study group we found 615 (38.8%) persons with macroscopic lesions in gut. Isolated linear ulcerations were identified in 7 pts (1.1%) while non-ulcerous lesions i.e. pseudomembranes, a variable degree of vasculature pruning & dwindling, mucosal lacerations and abnormalities such as erythema/edema/nodularity, or surface textural alteration in 608 pts (98.1%). The location of endoscopic findings was not reported in 27 articles. The distinct endoscopic findings were described in the left (descending, sigmoid, rectum - 10/21/11 studies), right (cecum, ascending - 7/7 studies), transverse colon (n=12), as well as duodenum (n=4), and terminal ileum (n=2). In 17 (1.1%) pts colonic perforation occurred. CONCLUSION Endoscopic findings are recognized with increased frequency in pts with MC. This could improve MC diagnosis by prompting a more extensive biopsy protocol in such cases and an earlier initiation of treatment. Procedure-related perforation has been reported in this group; therefore, cautious air insufflation is advisable when endoscopic findings are recognised.
Collapse
Affiliation(s)
- Wojciech Marlicz
- Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland.
| | | | - Diana E Yung
- Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Igor Loniewski
- Department of Biochemistry and Human Nutrition, Pomeranian Medical University, Szczecin, Poland; Sanprobi Sp. z o.o. Sp. K, Szczecin, Poland
| | | |
Collapse
|
|
2
|
Koulaouzidis A, Yung DE, Nemeth A, Sjöberg K, Giannakou A, Qureshi R, Bartzis L, McNeill M, Johansson GW, Lucendo AJ, Fineron P, Trimble KC, Saeed A, Plevris JN, Toth E. Macroscopic findings in collagenous colitis: a multi-center, retrospective, observational cohort study. Ann Gastroenterol 2017; 30:309-314. [PMID: 28469361 PMCID: PMC5411381 DOI: 10.20524/aog.2017.0131] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 12/28/2016] [Indexed: 12/16/2022] Open
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 Malmö (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 mean±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 66.9±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.
Collapse
Affiliation(s)
- Anastasios Koulaouzidis
- Endoscopy Unit, The Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK (Anastasios Koulaouzidis, Diana E. Yung, Leonidas Bartzis, Ken C. Trimble, John N. Plevris)
| | - Diana E. Yung
- Endoscopy Unit, The Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK (Anastasios Koulaouzidis, Diana E. Yung, Leonidas Bartzis, Ken C. Trimble, John N. Plevris)
| | - Artur Nemeth
- Endoscopy Unit, Skåne University Hospital, Malmö, Sweden (Artur Nemeth, Gabriele Wurm Johansson, Ervin Toth)
| | - Klas Sjöberg
- Department of Gastroenterology and Nutrition, Skåne University Hospital, Lund University, Malmö, Sweden (Klas Sjöberg)
| | - Andry Giannakou
- Faculty of Economics & Management, Open University of Cyprus, Nicosia, Cyprus (Andry Giannakou)
| | - Raheel Qureshi
- Gastroenterology Department, Queen Elizabeth Hospital, Gateshead, England, UK (Raheel Qureshi, Athar Saeed)
| | - Leonidas Bartzis
- Endoscopy Unit, The Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK (Anastasios Koulaouzidis, Diana E. Yung, Leonidas Bartzis, Ken C. Trimble, John N. Plevris)
| | - Morna McNeill
- Department of Pathology, Western General Hospital, Edinburgh, Scotland, UK (Morna McNeill, Paul Fineron)
| | - Gabriele Wurm Johansson
- Endoscopy Unit, Skåne University Hospital, Malmö, Sweden (Artur Nemeth, Gabriele Wurm Johansson, Ervin Toth)
| | - Alfredo J. Lucendo
- Gastroenterology Department, Hospital General de Tomelloso, Spain (Alfredo J. Lucendo)
| | - Paul Fineron
- Department of Pathology, Western General Hospital, Edinburgh, Scotland, UK (Morna McNeill, Paul Fineron)
| | - Ken C. Trimble
- Endoscopy Unit, The Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK (Anastasios Koulaouzidis, Diana E. Yung, Leonidas Bartzis, Ken C. Trimble, John N. Plevris)
| | - Athar Saeed
- Gastroenterology Department, Queen Elizabeth Hospital, Gateshead, England, UK (Raheel Qureshi, Athar Saeed)
| | - John N. Plevris
- Endoscopy Unit, The Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK (Anastasios Koulaouzidis, Diana E. Yung, Leonidas Bartzis, Ken C. Trimble, John N. Plevris)
| | - Ervin Toth
- Endoscopy Unit, Skåne University Hospital, Malmö, Sweden (Artur Nemeth, Gabriele Wurm Johansson, Ervin Toth)
| |
Collapse
|
|
3
|
Cottreau J, Kelly R, Topp T, Costa A, Filter ER, Arnason T. Spontaneous colonic perforation: a rare complication of collagenous colitis. Clin J Gastroenterol 2016; 9:140-4. [PMID: 27178398 DOI: 10.1007/s12328-016-0652-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 05/03/2016] [Indexed: 02/08/2023]
Abstract
Collagenous colitis is a clinicopathologic syndrome characterized by chronic watery diarrhea and unique histopathologic features. Spontaneous colonic perforation in the setting of collagenous colitis is a highly unusual complication, with only three cases reported in the literature to date. We present a fourth case and propose a potential pathologic mechanism for acute colonic perforation in this patient population.
Collapse
Affiliation(s)
| | - Ryan Kelly
- Dalhousie University Medical School, Halifax, NS, Canada.,Division of General Surgery, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | - Trevor Topp
- Dalhousie University Medical School, Halifax, NS, Canada.,Division of General Surgery, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | - Andreu Costa
- Dalhousie University Medical School, Halifax, NS, Canada.,Department of Diagnostic Imaging, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | - Emily R Filter
- Dalhousie University Medical School, Halifax, NS, Canada.,Division of Anatomical Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, 734a, MacKenzie Bldg, 5788 University Ave, Halifax, NS, B3H 1V8, Canada
| | - Thomas Arnason
- Dalhousie University Medical School, Halifax, NS, Canada. .,Division of Anatomical Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, 734a, MacKenzie Bldg, 5788 University Ave, Halifax, NS, B3H 1V8, Canada.
| |
Collapse
|
|
4
|
Toward reliable and rapid bedside diagnosis of spontaneous bacterial peritonitis in cirrhotic patients. EGYPTIAN LIVER JOURNAL 2014. [DOI: 10.1097/01.elx.0000445721.66780.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
|
5
|
Saito S, Tsumura T, Nishikawa H, Takeda H, Nakajima J, Kanesaka T, Matsuda F, Sakamoto A, Henmi S, Hatamaru K, Sekikawa A, Kita R, Maruo T, Okabe Y, Kimura T, Wakasa T, Osaki Y. Clinical characteristics of collagenous colitis with linear ulcerations. Dig Endosc 2014; 26:69-76. [PMID: 23560988 DOI: 10.1111/den.12083] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 02/06/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND The relationship between the thickness of subepithelial collagen bands (CB) and the development of linear ulcerations (LU) in collagenous colitis (CC) remains unclear. The aim of the present study was to compare the clinical and pathological features, including the thickness of CB, in CC patients with and without LU. PATIENTS AND METHODS Twenty-five patients with CC diagnosed by pathological examination of biopsy specimens were analyzed. Eleven patients with LU (LU group) and 14 patients without LU (non-LU group) were compared. RESULTS Ten patients in the LU group and seven in the non-LU group were taking lansoprazole (P = 0.038). Seven patients in the LU group and one in the non-LU group were taking non-steroidal anti-inflammatory drugs (NSAIDs) (P = 0.004). All LU were locatedin the transverse or left colon. Patients in the LU group were older than those in the non-LU group (P = 0.015). CB were significantly thicker in the LU group than in the non-LU group (mean ± SD, 40 ± 21 μm vs 20 ± 11 μm, P = 0.004). Multivariate analysis showed that NSAIDs use (odds ratio, 19.236; 95% confidence interval, 1.341-275.869) and CB thickness (odds ratio, 0.893; 95% confidence interval, 0.804-0.999) were independently associated with the development of LU. CONCLUSION Use of lansoprazole and NSAIDs, thick CB, and advanced age are associated with the development of LU in CC patients.
Collapse
Affiliation(s)
- Sumio Saito
- Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
6
|
Ianiro G, Cammarota G, Valerio L, Annicchiarico BE, Milani A, Siciliano M, Gasbarrini A. Microscopic colitis. World J Gastroenterol 2012; 18:6206-6215. [PMID: 23180940 PMCID: PMC3501768 DOI: 10.3748/wjg.v18.i43.6206] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Microscopic colitis may be defined as a clinical syndrome, of unknown etiology, consisting of chronic watery diarrhea, with no alterations in the large bowel at the endoscopic and radiologic evaluation. Therefore, a definitive diagnosis is only possible by histological analysis. The epidemiological impact of this disease has become increasingly clear in the last years, with most data coming from Western countries. Microscopic colitis includes two histological subtypes [collagenous colitis (CC) and lymphocytic colitis (LC)] with no differences in clinical presentation and management. Collagenous colitis is characterized by a thickening of the subepithelial collagen layer that is absent in LC. The main feature of LC is an increase of the density of intra-epithelial lymphocytes in the surface epithelium. A number of pathogenetic theories have been proposed over the years, involving the role of luminal agents, autoimmunity, eosinophils, genetics (human leukocyte antigen), biliary acids, infections, alterations of pericryptal fibroblasts, and drug intake; drugs like ticlopidine, carbamazepine or ranitidine are especially associated with the development of LC, while CC is more frequently linked to cimetidine, non-steroidal antiinflammatory drugs and lansoprazole. Microscopic colitis typically presents as chronic or intermittent watery diarrhea, that may be accompanied by symptoms such as abdominal pain, weight loss and incontinence. Recent evidence has added new pharmacological options for the treatment of microscopic colitis: the role of steroidal therapy, especially oral budesonide, has gained relevance, as well as immunosuppressive agents such as azathioprine and 6-mercaptopurine. The use of anti-tumor necrosis factor-α agents, infliximab and adalimumab, constitutes a new, interesting tool for the treatment of microscopic colitis, but larger, adequately designed studies are needed to confirm existing data.
Collapse
|
|
7
|
Koulaouzidis A, Saeed AA. Distinct colonoscopy findings of microscopic colitis: Not so microscopic after all? World J Gastroenterol 2011; 17:4157-65. [PMID: 22072846 PMCID: PMC3209563 DOI: 10.3748/wjg.v17.i37.4157] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Revised: 05/20/2011] [Accepted: 05/27/2011] [Indexed: 02/06/2023] Open
Abstract
Microscopic colitis (MC) is considered an “umbrella term”, comprising two subtypes, i.e., collagenous colitis (CC) and lymphocytic colitis (LC). They are classically associated with normal or unremarkable colonoscopy. In the last few years, reports have been published revealing findings that are thought to be characteristic or pathognomonic of MC, especially CC. A systematic electronic and manual search of PubMed and EMBASE (to December 2010), for publications on distinct endoscopic findings in MC, resulted in 42 relevant reports for inclusion in this review. Eighty eight patients with collagenous colitis were presented. Only one publication describing a distinct endoscopic pattern in LC was found. Typical findings in CC are alteration of the vascular mucosal pattern, mucosal nodularity, a sequence of change from mucosal defects to mucosal cicatricial lesions, and perhaps (although of doubtful relevance) mucosal pseudomembranes. A causal connection of mucosal defects with the use of lansoprazole seems to exist. Adoption of the proposed lesion description herein is recommended in order to improve homogeneity of future reports.
Collapse
|
|
8
|
Cimmino DG, Mella JM, Pereyra L, Luna PAE, Casas G, Caldo I, Popoff F, Pedreira S, Boerr LA. A colorectal mosaic pattern might be an endoscopic feature of collagenous colitis. J Crohns Colitis 2010; 4:139-43. [PMID: 21122497 DOI: 10.1016/j.crohns.2009.09.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Revised: 08/22/2009] [Accepted: 09/08/2009] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The endoscopic aspect of the colorectal mucosa in those patients with collagenous colitis is usually normal, or with non-specific changes. Until now it had never been related to a mucosal pattern of mosaic type. Our aim was to determine the diagnostic accuracy of the presence of mosaic pattern in the colorectal mucosa for collagenous colitis. METHODS Patients who had undergone a colonoscopy with random biopsies performed in the diagnostic evaluation of chronic diarrhea between 2004 and 2008 were studied. We defined patients with chronic diarrhea and mosaic mucosal pattern as "cases", and patients with chronic diarrhea without mosaic pattern as "controls". The odds ratio (OR) of finding a collagenous colitis in view of a mosaic pattern in colon was determined; as well as sensitivity and specificity; positive and negative likelihood ratios (LR+, LR-), considering this finding as a diagnostic instrument for collagenous colitis. RESULTS 252 patients who had undergone colonoscopy with biopsy due to chronic diarrhea were analyzed. In 6 patients, a mosaic pattern was identified in the colorectal mucosa. The histological diagnose of 36 of the 252 patients (14%) was microscopic colitis, 27 of which (11%) had collagenous colitis. The colonoscopy was found normal in 21 of these 27 patients; in 2 patients, congestion or petechiae was found in the rectum; and in 4 patients (15%), all women, a mosaic pattern was found in the rectosigmoid mucosa. The OR of this finding was 19.4 (CI 95% 3.9-95.4) for collagenous colitis. It had a sensitivity of 14.8% (CI 95% 6.8-20), a specificity of 99.1% (CI 95% 98.2-99.7), LR+ of 16.6 (CI 95% 3.7-76.4), and LR- of 0.86 (CI 95% 0.80-0.95) for a collagenous colitis. CONCLUSION The mosaic pattern in the colorectal mucosa of patients studied due to chronic diarrhea could be a distinguishing feature of collagenous colitis.
Collapse
Affiliation(s)
- Daniel G Cimmino
- Endoscopy Unit and Gastroenterology Unit, Hospital Alemán, Buenos Aires, Argentina.
| | | | | | | | | | | | | | | | | |
Collapse
|
|
9
|
Mucosal scars in collagenous colitis. Gastrointest Endosc 2010; 71:221-2; author reply 222. [PMID: 20105482 DOI: 10.1016/j.gie.2009.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2009] [Accepted: 05/01/2009] [Indexed: 12/15/2022]
|
|
10
|
Couto G, Bispo M, Barreiro P, Monteiro L, Matos L. Unique endoscopy findings in collagenous colitis. Gastrointest Endosc 2009; 69:1186-8. [PMID: 19152884 DOI: 10.1016/j.gie.2008.06.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2008] [Accepted: 06/09/2008] [Indexed: 02/08/2023]
Affiliation(s)
- Gilberto Couto
- Gastroenterology Department, Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | | | | | | | | |
Collapse
|
|
11
|
Sekioka T, Saitou M, Tanaka T, Takeda S, Kumamoto S, Kajiwara M, Nakai O, Yamada T. A Case of Lansoprazole-associated Collagenous Colitis with Peritonitis Accompanying Endoscopically Fractured Colon. ACTA ACUST UNITED AC 2009. [DOI: 10.3862/jcoloproctology.62.527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
|
12
|
Umeno J, Matsumoto T, Nakamura S, Jo Y, Yada S, Hirakawa K, Yoshimura R, Yamagata H, Kudo T, Hirano A, Gushima M, Yao T, Nakashima Y, Iida M. Linear mucosal defect may be characteristic of lansoprazole-associated collagenous colitis. Gastrointest Endosc 2008; 67:1185-91. [PMID: 18513560 DOI: 10.1016/j.gie.2008.02.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2007] [Accepted: 02/07/2008] [Indexed: 02/08/2023]
Abstract
BACKGROUND Although some cases of collagenous colitis have been induced by lansoprazole (LPZ), the clinicopathologic features of LPZ-associated collagenous colitis have not been elucidated. OBJECTIVE To elucidate the clinical, endoscopic, and histopathologic features of LPZ-associated collagenous colitis. DESIGN Retrospective case study. PATIENTS The subjects were 13 patients with collagenous colitis diagnosed during a period from 2002 to 2007. MAIN OUTCOME MEASUREMENTS The colonoscopic and histopathologic findings were compared retrospectively between 9 cases of LPZ use (LPZ group) and 4 cases without the use of LPZ (non-LPZ group). RESULTS A colonoscopy revealed a linear mucosal defect more frequently in the LPZ group (7 of 9 cases [78%]) than in the non-LPZ group (0 of 4 cases [0%], P = .02). Friable mucosa was also noted in 4 patients (44%) in the LPZ group but none in the non-LPZ group. The colonoscopic finding in the non-LPZ group was either normal mucosa or nonspecific minimal abnormalities, whereas patients in the LPZ group had either a linear mucosal defect, mucosal bleeding, or both (P = .001). On histologic examination, the subepithelial collagen band was thicker in patients in the LPZ group than in those in the non-LPZ group (median 45 vs 26.3 mum). All patients in the LPZ group recovered from diarrhea after discontinuance of LPZ. LIMITATION A small number of patients. CONCLUSIONS Linear mucosal defects and friable mucosa may be characteristic colonoscopic findings in cases of LPZ-associated collagenous colitis.
Collapse
Affiliation(s)
- Junji Umeno
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
13
|
Kaplan GG, Seminowich S, Williams J, Muruve D, Dupre M, Urbanski SJ, Yilmaz S, Burak KW, Beck PL. The risk of microscopic colitis in solid-organ transplantation patients: a population-based study. Transplantation 2008; 85:48-54. [PMID: 18192911 DOI: 10.1097/01.tp.0000298001.66377.a2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Microscopic colitis (MC) has not been recognized as a complication of transplantation because patients are on immunosuppressant medications. The objective of this work was to describe the risk of developing MC after solid-organ transplantation. METHODS This population-based cohort study identified all cases of MC diagnosed after kidney, kidney and pancreas, or liver transplantation using pathology and transplantation databases. The annual incidence and point prevalence of MC after transplantation was calculated. The incidence rate of MC among transplantation patients was compared with the general population and presented as a Standardized Incidence Ratio (SIR) with 95% confidence intervals. RESULTS Seven cases (0.9%) of MC were diagnosed in kidney (n=2), kidney and pancreas (n=1), and liver (n=4) transplantation recipients. The point prevalence of MC was 8.8 per 1000 transplantation recipients. The annual incidence rate of MC in solid-organ transplantation patients was 5.0 cases per 1000 person-years. The SIR of developing MC after transplantation was 50.5 (95% confidence interval 13.6-131.8). The average age of diagnosis of MC was 49.4+/-5.3 years, average time of onset from transplantation was 67.4+/-27.0 months, and the average latency period was 30.1+/-9.0 months. Once diagnosed, all patients responded to MC-specific therapy. CONCLUSION Physicians should have a low threshold to investigate for MC in solid-organ transplantation recipients who present with chronic diarrhea because this population is at an increased risk of developing MC.
Collapse
Affiliation(s)
- Gilaad G Kaplan
- Division of Gastroenterology, Gastrointestinal Research Group, Southern Alberta Transplant Program, Department of Pathology, University of Calgary, Calgary, Alberta, Canada
| | | | | | | | | | | | | | | | | |
Collapse
|