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Difference between revisions of "Collagenous colitis"
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'''Collagenous_colitis''' is a type of [[colitis]] has a characteristic clinical presentation and no apparent endoscopic changes. It is a type of [[microscopic colitis]]. | |||
==General== | |||
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> | |||
*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/> | |||
Notes: | |||
*Clinical DDx includes [[irritable bowel syndrome]] - which has no or subtle histopathologic changes. | |||
===Epidemiology=== | |||
*Age: a disease of adults - usually 50s. | |||
*Sex: | |||
**LC males ~= females,<ref name=medscape180664/> | |||
**CC females:males = 20:1.<ref name=medscape180664/> | |||
*Drugs are associated with LC and CC. | |||
**NSAIDs - posulated association/weak association, | |||
**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> | |||
*No increased risk of colorectal carcinoma.<ref name=pmid19109861/> | |||
===Treatment=== | |||
*Sometimes just follow-up. | |||
*Steroids - budesonide -- short-term treatment.<ref name=pmid19109861/> | |||
==Gross== | |||
*Endoscopic examination is normal. | |||
**This is why it is called a ''[[microscopic colitis]]''. | |||
==Microscopic== | |||
Features: | |||
*Intraepithelial lymphocytes - '''important'''. | |||
*Collagenous material in the lamina propria (pink on H&E) -- '''key feature'''. | |||
**Can be demonstrated with a trichrome stain -- collagen = green on trichrome. | |||
**Subepithelial collagen needs to be >= 10 micrometres thick for diagnosis.<ref name=pmid19109861/> | |||
***8 micrometres is the diameter of a [[RBC]]. | |||
***The normal thickness of the subepithelial collagen is 3 micrometres.<ref name=pmid19109861/> | |||
***Transverse colon usually thickest - in one series ~ 47 micrometres on average.<ref name=pmid10208468>{{Cite journal | last1 = Offner | first1 = FA. | last2 = Jao | first2 = RV. | last3 = Lewin | first3 = KJ. | last4 = Havelec | first4 = L. | last5 = Weinstein | first5 = WM. | title = Collagenous colitis: a study of the distribution of morphological abnormalities and their histological detection. | journal = Hum Pathol | volume = 30 | issue = 4 | pages = 451-7 | month = Apr | year = 1999 | doi = | PMID = 10208468 }}</ref> | |||
**Thickening is usually patchy.<ref name=pmid1740280/> | |||
**Thickening "follows the crypts from the surface" - useful for differentiating from tangential sections of the basement membrane.<ref name=bell>Bell, D. 4 Mar 2009.</ref> | |||
**Collagen may envelope capillaries - useful to discern from basement membrane.<ref name=bell>Bell, D. 4 Mar 2009.</ref> | |||
Notes: | |||
*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/> | |||
**No [[PMN]]s. | |||
**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> | |||
===Images=== | |||
<gallery> | |||
Image:Collagenous_colitis_-_intermed_mag.jpg | CC - intermed mag. (WC/Nephron) | |||
Image:Collagenous_colitis_-_high_mag.jpg | CC - high mag. (WC/Nephron) | |||
</gallery> | |||
===Sign out=== | |||
<pre> | |||
TRANSVERSE COLON, BIOPSY: | |||
- COLLAGENOUS COLITIS. | |||
</pre> | |||
===Micro=== | |||
The sections show colonic mucosa with abundant intraepithelial lymphocytes (>20 lymphocytes/100 surface epithelial cells). A prominent collagen band is apparent below the epithelium (>10 micrometres thick). The glandular architecture is within normal limits. | |||
There are no granulomas. No neutrophilic cryptitis is apparent. The epithelium matures | |||
appropriately to the surface. | |||
==See also== | |||
*[[Colon]]. | |||
*[[Lymphocytic colitis]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||
[[Category:Colon]] | |||
[[Category:Gastrointestinal pathology]] | |||