Published online Nov 15, 2016. doi: 10.4291/wjgp.v7.i4.307
Peer-review started: June 22, 2016
First decision: September 1, 2016
Revised: September 3, 2016
Accepted: September 21, 2016
Article in press: September 22, 2016
Published online: November 15, 2016
To evaluate the potential association between mild duodenal damage and microscopic colitis (MC).
We retrospectively included 105 consecutive patients with type I Marsh-Oberhuber duodenal damage and negativity for immunoglobulin A anti-endomysium and anti-tissue transglutaminase. The following parameters were analyzed: Sex, age at execution of esophagogastroduodenoscopy, duodenal damage, and number of intraepithelial lymphocytes at biopsies, prevalence of Helicobacter pylori infection, age at execution of colonoscopy, macroscopic and microscopic features of colonoscopy, family history of gastrointestinal and autoimmune diseases, smoking habits, biochemical parameters of inflammation and autoimmunity, use of proton pump inhibitors or nonsteroidal anti-inflammatory drugs, adverse reactions to drugs or foods, pathologies known to be associated with celiac disease or MC, living on a gluten-free diet or on a gluten-low diet for at least 1 mo.
Colonoscopy was performed in 59 patients, but only in 48 of them biopsies were taken in the entire colon. Considering the latter cohort, the diagnosis of MC was met in 25 (52.1%) patients while in 18 patients other pathologic findings were reported: 13 (27%) cases of nonspecific inflammatory bowel disease, 2 (4.2%) cases of Crohn’s disease, 2 (4.2%) cases of eosinophilic gastroenteritis, and 1 (2.1%) case of autoimmune enteritis. Five (10.4%) patients had a normal colonoscopic result. Matching the groups by age, and considering only patients who underwent colonoscopy (42.7 ± 15.5 years) vs those who did not undergo colonoscopy (36.9 ± 10.6 years), a statistical difference was found (P = 0.039). Focusing on symptoms, diarrhea was statistically more prevalent in MC group than in patients who did not undergo colonoscopy (P = 0.03).
Mild duodenal damage is associated with MC in more than half of the cases. This association supports the hypothesis of a link between these two entities.
Core tip: Scarce information is available on patients with symptoms suggestive for celiac disease but with negative serologic tests and mild duodenal damage (type I Marsh-Oberhuber classification). Our data show that mild duodenal damage is associated with microscopic colitis in more than the half of the investigated cases. This association may support the hypothesis of a new clinical and pathological entity, the “lymphocytic enterocolitis”.