Posts Tagged ‘Watery Diarrhea’

Microscopic Colitis

05.14.10

Microscopic colitis refers to inflammation of the colon that is only visible when the colon’s lining is examined under a microscope. The appearance of the inner colon lining in microscopic colitis is normal by visual inspection during colonoscopy or flexible sigmoidoscopy.

The diagnosis of microscopic colitis is made when a doctor, while performing colonoscopy or flexible sigmoidoscopy, takes biopsies (small samples of tissue) of the normal-appearing lining, and then examines the biopsies under a microscope. There are two types of microscopic colitis; lymphocytic colitis and collagenous colitis. In lymphocytic colitis, there is an accumulation of lymphocytes (a type of white blood cell) within the lining of the colon.

In collagenous colitis, there is an additional layer of collagen (scar tissue) just below the lining. Some experts believe that lymphocytic colitis and collagenous colitis represent different stages of the same disease. The inflammation and the collagen probably interfere with absorption of water from the colon, and cause the diarrhea. The primary symptom of microscopic colitis is chronic, watery diarrhea. Patients with microscopic colitis can have diarrhea for months or years before the diagnosis is made.

This chronic diarrhea of microscopic colitis is different from the acute diarrhea of infectious colitis, which typically lasts only days to weeks. Some patients with microscopic colitis also may report mild abdominal cramps and pain. Blood in the stool is unusual. The prevalence of microscopic colitis in the U.S. is not clearly known.

It is estimated that 10-20% of patients with chronic diarrhea may have microscopic colitis. It is this author’s experience, that the condition is becoming more common in recent years. It is not clear, however, whether there is an actual increase in the frequency of microscopic colitis or whether doctors are just better at diagnosing it.

Microscopic colitis most commonly occurs in middle aged to elderly patients and is more common among women than men. The cause(s) of microscopic colitis is unknown. Some doctors suspect that microscopic colitis is an autoimmune disorder similar to the autoimmune disorders that cause chronic ulcerative colitis and Crohns disease.

The diagnosis of microscopic colitis is made by performing biopsies from different regions of the colon during colonoscopy or sigmoidoscopy. The abnormalities of the colon’s lining in microscopic colitis occur in a patchy distribution (areas of normal lining may exist adjacent to areas of abnormal lining).

For this reason, multiple biopsies should be taken from several different regions of the colon in order to accurately make a diagnosis. The patchy nature of microscopic colitis also is the reason why flexible sigmoidoscopy often is inadequate in diagnosing the condition because the abnormalities of microscopic colitis may be absent from the sigmoid colon (the colonic segment that is closest to the rectum and is within the reach of a sigmoidoscope) in 30-40% of the patients with microscopic colitis.

Thus, biopsies of other regions of the colon accessible only with colonoscopy may be necessary for diagnosing microscopic colitis.

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Lymphocytic Colitis

05.08.10

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 (lamina propria).

No definite etiology has been determined. Some reports have implicated long-term usage of NSAIDs, antidepressants, and other drugs; and overactive immune responses are also suspected. Over-the-counter antidiarrheal drugs are effective for many people with lymphocytic colitis. Anti-inflammatory drugs, such as salicylates may also help.

Corticosteroids or Mesalazines may be prescribed for people who do not respond to other drug treatment. The long-term prognosis for this disease is not clear. Lymphocytic colitis is closely related to collagenous colitis. Both are characterized by a syndrome of watery diarrhea, usually occurring in young to middle aged women. The etiology is unknown but an autoimmune basis has long been suspected.

However, an infectious etiology has not been excluded. In favor of an infectious etiology are cases associated with an outbreak of Brainerd diarrhea aboard a cruise ship. Brainerd diarrhea has been applied to cases of diarrhea of unknown etiology with an acute onset and prolonged duration.

Like collagenous colitis, a chronic watery diarrhea is present, but this lasts longer than 6 months and frequently for many years. Biopsies show similar features to lymphocytic colitis except there may a lesser degree of lymphocytic infiltration. lymphocytic colitis, is considered now an important cause of diarrhea in middle aged and elderly patients.

In this entity, endoscopic and radiological examinations are normal while specific histological findings are seen on colonic biopsy. Once the diagnosis of MC is confirmed, a stepwise approach with medical therapy is suggested. Ruling out other causes of chronic diarrhea should be the initial step. Once the diagnosis of MC is confirmed, a stepwise treatment algorithm is suggested.

In this review, I will introduce the entity of MC and describe the stepwise approach to diagnosis and management by reviewing the available evidence. The literature was reviewed regarding both collagenous colitis and lymphocystic colitits focusing on clinical trails. This was then critically examined and an approach to the diagnosis and management of microscopic colitis was suggested. there is inflammation in the lamina propria of the colonic mucosa, with increased intraepithelial lymphocytes.

Specifically in CC and not in LC, there is, in addition, marked thickening of the sub-epithelial collagen layer, which is the hallmark of this disease. This disease entity has attracted a lot of attention recently as an important and relatively common cause of chronic diarrhea.

The initial description of MC was first published in 1976 and since that time, it has been increasingly recognized as a relatively common cause of chronic diarrhea.

Collagenous Colitis

07.23.09

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.

On colonoscopy, 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.

Treatment of collagenous colitis is often challenging, and many agents have been used therapeutically:
•    Bismuth agents, including Pepto-Bismol
•    5-aminosalicylic acid
•    Budesonide
•    Immunosuppressants, including azathioprine
•    Corticosteroids

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.

Collagenous colitis (CC) is a recently described clinico-pathologic entity characterized by intractable chronic watery diarrhea, crampy abdominal pain, normal or near normal colonoscopic examination and histologically by a thickened subepithelial collagenous band associated with chronic inflammatory reaction and increased intraepithelial lymphocytic infiltrate in the colonic biopsies. Its pathogenesis remains nclear. We report a rare case of collagenous colitis in which immunohistochemical studies revealed marked deviations from normal in the endocrine elements of the colonic bowel.

To our knowledge this is the first report of such a study in collagenous colitis. Collagenous colitis is inflammation of the colon, the last portion of the digestive tract that ends at the rectum and anus. The most common symptom is chronic watery, non-bloody diarrhoea. In severe cases, the patient may be going to the toilet up to 20 times a day.
Collagenous colitis is a rare condition that affects about four people in every 10,000. It tends to develop in people aged over 40 years. Women outnumber men 20 to one, for reasons that are not clear.

There is no cure but lifestyle changes and medical treatment can manage the symptoms in most cases. Collagenous colitis is sometimes called microscopic colitis. Collagenous colitis seems to occasionally run in families, which suggests a genetic component to the condition.

However, doctors aren’t sure what causes the inflammation. One theory proposes that an unknown virus or bacterium is to blame. Another theory is that collagenous colitis is a type of autoimmune disorder, which means the immune system attacks a healthy part of the body by mistake. Some people with collagenous colitis also have other autoimmune disorders such as rheumatoid arthritis, scleroderma or Sjogren’s syndrome.

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