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Difference between revisions of "Collagenous colitis"
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{{ Infobox diagnosis | |||
| Name = {{PAGENAME}} | |||
| Image = Collagenous_colitis_-_high_mag.jpg | |||
| Width = | |||
| Caption = Collagenous colitis. [[H&E stain]]. | |||
| Micro = intraepithelial lymphocytes (>20/100 enterocytes), subepithelial collagen band (>= 10 micrometres thick) | |||
| Subtypes = | |||
| LMDDx = [[lymphocytic colitis]], [[Crohn's disease]] (very rare) | |||
| Stains = | |||
| IHC = | |||
| EM = | |||
| Molecular = | |||
| IF = | |||
| Gross = | |||
| Grossing = | |||
| Site = [[colon]] - typically more prominent proximally | |||
| Assdx = | |||
| Syndromes = | |||
| Clinicalhx = predominantly women (women:men=20:1) | |||
| Signs = | |||
| Symptoms = diarrhea, non-bloody | |||
| Prevalence = | |||
| Bloodwork = | |||
| Rads = | |||
| Endoscopy = normal | |||
| Prognosis = | |||
| Other = | |||
| ClinDDx = [[irritable bowel syndrome]], [[lymphocytic colitis]] | |||
}} | |||
'''Collagenous colitis''' is a type of [[microscopic colitis]]. It has a characteristic clinical presentation and no apparent endoscopic changes. | '''Collagenous colitis''' is a type of [[microscopic colitis]]. It has a characteristic clinical presentation and no apparent endoscopic changes. | ||
==General== | ==General== | ||
*Collagenous colitis may be related to [[lymphocytic colitis]]. | |||
**It is hypothesized that these conditions may be the same pathology at different time points.<ref name=medscape180664/> | |||
*May be associated with to [[collagenous gastritis]] in adults.<ref name=pmid19730387>{{Cite journal | last1 = Brain | first1 = O. | last2 = Rajaguru | first2 = C. | last3 = Warren | first3 = B. | last4 = Booth | first4 = J. | last5 = Travis | first5 = S. | title = Collagenous gastritis: reports and systematic review. | journal = Eur J Gastroenterol Hepatol | volume = 21 | issue = 12 | pages = 1419-24 | month = Dec | year = 2009 | doi = 10.1097/MEG.0b013e32832770fa | PMID = 19730387 }}</ref> | |||
Presentation: | Presentation: | ||
*Chronic diarrhea, non-bloody.<ref name=medscape180664>URL: [http://emedicine.medscape.com/article/180664-overview http://emedicine.medscape.com/article/180664-overview]. Accessed on: 31 May 2010.</ref> | *Chronic diarrhea, non-bloody.<ref name=medscape180664>URL: [http://emedicine.medscape.com/article/180664-overview http://emedicine.medscape.com/article/180664-overview]. Accessed on: 31 May 2010.</ref> | ||
Notes: | Notes: | ||
*Clinical DDx includes [[irritable bowel syndrome]] - which has no or subtle histopathologic changes. | *Clinical DDx includes [[irritable bowel syndrome]] - which has no or subtle histopathologic changes. | ||
*This pathology also afflicits rectum; however, it is less commonly found there. | |||
**The rectum is afflicted in approximately in 65% of cases.<ref name=pmid12018911>{{cite journal |author=Agnarsdottir M, Gunnlaugsson O, Orvar KB, ''et al.'' |title=Collagenous and lymphocytic colitis in Iceland |journal=Dig. Dis. Sci. |volume=47 |issue=5 |pages=1122–8 |year=2002 |month=May |pmid=12018911 |doi= |url=}}</ref> | |||
===Epidemiology=== | ===Epidemiology=== | ||
| Line 17: | Line 49: | ||
**CC females:males = 20:1.<ref name=medscape180664/> | **CC females:males = 20:1.<ref name=medscape180664/> | ||
*Drugs are associated with LC and CC. | *Drugs are associated with LC and CC. | ||
** | **[[NSAID]]s - posulated association/weak association, | ||
**SSRIs (used primarily for depression) - moderate association, dependent on specific drug. | **SSRIs (used primarily for depression) - moderate association, dependent on specific drug. | ||
*Associated with autoimmune disorders - [[celiac disease]], [[diabetes mellitus]], [[thyroid]] disorders and [[arthritis]].<ref name=pmid19109861>{{cite journal |author=Tysk C, Bohr J, Nyhlin N, Wickbom A, Eriksson S |title=Diagnosis and management of microscopic colitis |journal=World J. Gastroenterol. |volume=14 |issue=48 |pages=7280-8 |year=2008 |month=December |pmid=19109861 |doi= |url=http://www.wjgnet.com/1007-9327/14/7280.asp}}</ref> | *Associated with autoimmune disorders - [[celiac disease]], [[diabetes mellitus]], [[thyroid]] disorders and [[arthritis]].<ref name=pmid19109861>{{cite journal |author=Tysk C, Bohr J, Nyhlin N, Wickbom A, Eriksson S |title=Diagnosis and management of microscopic colitis |journal=World J. Gastroenterol. |volume=14 |issue=48 |pages=7280-8 |year=2008 |month=December |pmid=19109861 |doi= |url=http://www.wjgnet.com/1007-9327/14/7280.asp}}</ref> | ||
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==Microscopic== | ==Microscopic== | ||
Features: | Features: | ||
*Intraepithelial lymphocytes - '''important'''. | *[[Intraepithelial lymphocytes]] - '''important'''. | ||
*Collagenous material in the lamina propria (pink on H&E) -- '''key feature'''. | *Collagenous material in the lamina propria (pink on H&E) -- '''key feature'''. | ||
**Can be demonstrated with a trichrome stain -- collagen = green on trichrome. | **Can be demonstrated with a trichrome stain -- collagen = green on trichrome. | ||
| Line 45: | Line 77: | ||
Notes: | Notes: | ||
*CC is typically more prominent in the proximal colon - may reflect concentration gradient of offending causitive agents.<ref name=pmid19109861/> | *CC is typically more prominent in the proximal colon - may reflect concentration gradient of offending causitive agents.<ref name=pmid19109861/> | ||
*Significant negative findings:<ref name=hopkins_cc_lc/> | *Significant negative findings:<ref name=hopkins_cc_lc>[http://hopkins-gi.nts.jhu.edu/pages/latin/templates/index.cfm?pg=disease1&disease=29&organ=6&lang_id=1 http://hopkins-gi.nts.jhu.edu/pages/latin/templates/index.cfm?pg=disease1&disease=29&organ=6&lang_id=1]</ref> | ||
**No [[PMN]]s. | **No [[PMN]]s. | ||
**No crypt distortion. | **No crypt distortion. | ||
*Thickened collagen band uncommon in rectum.<ref name=pmid1740280>{{Cite journal | last1 = Tanaka | first1 = M. | last2 = Mazzoleni | first2 = G. | last3 = Riddell | first3 = RH. | title = Distribution of collagenous colitis: utility of flexible sigmoidoscopy. | journal = Gut | volume = 33 | issue = 1 | pages = 65-70 | month = Jan | year = 1992 | doi = | PMID = 1740280 }}</ref> | *Thickened collagen band uncommon in rectum.<ref name=pmid1740280>{{Cite journal | last1 = Tanaka | first1 = M. | last2 = Mazzoleni | first2 = G. | last3 = Riddell | first3 = RH. | title = Distribution of collagenous colitis: utility of flexible sigmoidoscopy. | journal = Gut | volume = 33 | issue = 1 | pages = 65-70 | month = Jan | year = 1992 | doi = | PMID = 1740280 }}</ref> | ||
*Described in association of [[pseudomembranous colitis|pseudomembranes]].<ref name=pmid14508399>{{Cite journal | last1 = Yuan | first1 = S. | last2 = Reyes | first2 = V. | last3 = Bronner | first3 = MP. | title = Pseudomembranous collagenous colitis. | journal = Am J Surg Pathol | volume = 27 | issue = 10 | pages = 1375-9 | month = Oct | year = 2003 | doi = | PMID = 14508399 }}</ref> | |||
DDx: | |||
*[[Lymphocytic colitis]]. | |||
*[[Crohn's disease]] - very rare, may be a perfect mimic.<ref name=pmid10478667>{{Cite journal | last1 = Goldstein | first1 = NS. | last2 = Gyorfi | first2 = T. | title = Focal lymphocytic colitis and collagenous colitis: patterns of Crohn's colitis? | journal = Am J Surg Pathol | volume = 23 | issue = 9 | pages = 1075-81 | month = Sep | year = 1999 | doi = | PMID = 10478667 }}</ref> | |||
===Images=== | ===Images=== | ||