Collagenous colitis
Encyclopedia
Collagenous colitis is an inflammatory
colonic
disease with peak incidence in the 5th decade of life, affecting women more than men. Its clinical presentation involves watery diarrhea, usually in the absence of rectal bleeding. It is often classified under the umbrella entity microscopic colitis
, along with a related condition, lymphocytic colitis
.
, the mucosa of the colon
typically looks normal, but biopsies
of affected tissue usually show deposition of collagen
in the lamina propria
, which is the area of connective tissue
between colonic glands. Radiological tests, such as a barium enema
are typically normal.
s such as diclofenac
are commonly implicated. The other group of agents most commonly associated with collagenous colitis are the selective serotonin reuptake inhibitors used in the treatment of depression.
Pilot investigational studies have shown some evidence of possible benefit for both Boswellia serrata
extract and specific strains of probiotics in the treatment of collegenous colitis, although larger sample sizes are needed to confirm the results.
There have also been reports of an association between collagenous colitis and lymphoma.
Inflammatory bowel disease
In medicine, inflammatory bowel disease is a group of inflammatory conditions of the colon and small intestine. The major types of IBD are Crohn's disease and ulcerative colitis.-Classification:...
colonic
Colon (anatomy)
The colon is the last part of the digestive system in most vertebrates; it extracts water and salt from solid wastes before they are eliminated from the body, and is the site in which flora-aided fermentation of unabsorbed material occurs. Unlike the small intestine, the colon does not play a...
disease with peak incidence in the 5th decade of life, affecting women more than men. Its clinical presentation involves watery diarrhea, usually in the absence of rectal bleeding. It is often classified under the umbrella entity microscopic colitis
Microscopic colitis
Microscopic colitis refers to two medical conditions which cause diarrhea: collagenous colitis and lymphocytic colitis. Both conditions are characterised by the following triad of clinicopathological features:# Chronic watery diarrhoea;# Normal colonoscopy;...
, along with a related condition, lymphocytic colitis
Lymphocytic colitis
Lymphocytic colitis, a subtype of microscopic colitis, is a rare condition characterized by chronic non-bloody watery diarrhea. The colonoscopy is normal but the mucosal biopsy reveals an accumulation of lymphocytes in the colonic epithelium and connective tissue...
.
Diagnosis
On colonoscopyColonoscopy
Colonoscopy is the endoscopic examination of the large bowel and the distal part of the small bowel with a CCD camera or a fiber optic camera on a flexible tube passed through the anus. It may provide a visual diagnosis and grants the opportunity for biopsy or removal of suspected...
, the mucosa of the colon
Colon (anatomy)
The colon is the last part of the digestive system in most vertebrates; it extracts water and salt from solid wastes before they are eliminated from the body, and is the site in which flora-aided fermentation of unabsorbed material occurs. Unlike the small intestine, the colon does not play a...
typically looks normal, but biopsies
Biopsy
A biopsy is a medical test involving sampling of cells or tissues for examination. It is the medical removal of tissue from a living subject to determine the presence or extent of a disease. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically...
of affected tissue usually show deposition of collagen
Collagen
Collagen is a group of naturally occurring proteins found in animals, especially in the flesh and connective tissues of mammals. It is the main component of connective tissue, and is the most abundant protein in mammals, making up about 25% to 35% of the whole-body protein content...
in the lamina propria
Lamina propria
The lamina propria is a constituent of the moist linings known as mucous membranes or mucosa, which line various tubes in the body ....
, which is the area of connective tissue
Connective tissue
"Connective tissue" is a fibrous tissue. It is one of the four traditional classes of tissues . Connective Tissue is found throughout the body.In fact the whole framework of the skeleton and the different specialized connective tissues from the crown of the head to the toes determine the form of...
between colonic glands. Radiological tests, such as a barium enema
Barium enema
A lower gastrointestinal series, also called a barium enema, is a medical procedure used to examine and diagnose problems with the human colon . X-ray pictures are taken while barium sulfate fills the colon via the rectum.-Procedure:...
are typically normal.
Causes
The exact cause of collagenous colitis is unknown, but the effects of non-steroidal anti-inflammatory drugNon-steroidal anti-inflammatory drug
Nonsteroidal anti-inflammatory drugs, usually abbreviated to NSAIDs or NAIDs, but also referred to as nonsteroidal anti-inflammatory agents/analgesics or nonsteroidal Anti-inflammatory medicines , are drugs with analgesic and antipyretic effects and which have, in higher doses, anti-inflammatory...
s such as diclofenac
Diclofenac
Diclofenac is a non-steroidal anti-inflammatory drug taken to reduce inflammation and as an analgesic reducing pain in certain conditions....
are commonly implicated. The other group of agents most commonly associated with collagenous colitis are the selective serotonin reuptake inhibitors used in the treatment of depression.
Treatment
Treatment of collagenous colitis is often challenging, and many agents have been used therapeutically:- BismuthBismuthBismuth is a chemical element with symbol Bi and atomic number 83. Bismuth, a trivalent poor metal, chemically resembles arsenic and antimony. Elemental bismuth may occur naturally uncombined, although its sulfide and oxide form important commercial ores. The free element is 86% as dense as lead...
agents, including Pepto-BismolPepto-BismolPepto-Bismol is an over-the-counter drug currently produced by the Procter and Gamble company in the United States of America and in Canada to treat minor digestive system upset. Its active ingredient is bismuth subsalicylate... - 5-aminosalicylic acid
- BudesonideBudesonideBudesonide is a glucocorticoid steroid for the treatment of asthma and non-infectious rhinitis , and for treatment and prevention of nasal polyposis...
- Immunosuppressants, including azathioprineAzathioprineAzathioprine is a purine analogue immunosuppressive drug. It is used to prevent organ rejection following organ transplantation and to treat a vast array of autoimmune diseases, including rheumatoid arthritis, pemphigus, inflammatory bowel disease , multiple sclerosis, autoimmune hepatitis, atopic...
- Corticosteroids
Pilot investigational studies have shown some evidence of possible benefit for both Boswellia serrata
Boswellia serrata
Boswellia serrata is Indian frankincense or Salai. It is found in Rajasthan, Madhya Pradesh & Andhara Pradesh in India.- Medical usage :...
extract and specific strains of probiotics in the treatment of collegenous colitis, although larger sample sizes are needed to confirm the results.
Disease associations
An association between collagenous colitis and celiac disease has been reported, but there is no evidence that dietary restrictions used in celiac disease management are of benefit in collagenous colitis therapy.There have also been reports of an association between collagenous colitis and lymphoma.