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Pilot-scale studies have shown some evidence of possible benefit for both ''[[Boswellia serrata]]'' extract and specific strains of [[probiotics]] in the treatment of collagenous colitis, although larger sample sizes are needed to confirm the results.<ref>{{cite journal |vauthors=Madisch A, Miehlke S, Eichele O, Mrwa J, Bethke B, Kuhlisch E, Bästlein E, Wilhelms G, Morgner A, Wigginghaus B, Stolte M |title=''Boswellia serrata'' extract for the treatment of collagenous colitis. A double-blind, randomized, placebo-controlled, multicenter trial |journal=International Journal of Colorectal Disease |volume=22 |issue=12 |pages=1445–51 |date=Dec 2007 |pmid=17764013 |doi=10.1007/s00384-007-0364-1 |s2cid=206966118 }}</ref><ref>{{cite journal |vauthors=Wildt S, Munck LK, Vinter-Jensen L, Hanse BF, Nordgaard-Lassen I, Christensen S, Avnstroem S, Rasmussen SN, Rumessen JJ |title=Probiotic treatment of collagenous colitis: a randomized, double-blind, placebo-controlled trial with ''Lactobacillus acidophilus'' and ''Bifidobacterium animalis'' subsp. ''lactis'' |journal=Inflammatory Bowel Diseases |volume=12 |issue=5 |pages=395–401 |date=May 2006 |pmid=16670529 |doi=10.1097/01.MIB.0000218763.99334.49 |s2cid=870587 }}</ref><ref>{{cite journal |vauthors=Tromm A, Niewerth U, Khoury M, Baestlein E, Wilhelms G, Schulze J, Stolte M |title=The probiotic ''E. coli'' strain Nissle 1917 for the treatment of collagenous colitis: first results of an open-label trial |journal=Zeitschrift für Gastroenterologie |volume=42 |issue=5 |pages=365–9 |date=May 2004 |pmid=15136935 |doi=10.1055/s-2004-812709 |s2cid=3010852 }}</ref>
Pilot-scale studies have shown some evidence of possible benefit for both ''[[Boswellia serrata]]'' extract and specific strains of [[probiotics]] in the treatment of collagenous colitis, although larger sample sizes are needed to confirm the results.<ref>{{cite journal |vauthors=Madisch A, Miehlke S, Eichele O, Mrwa J, Bethke B, Kuhlisch E, Bästlein E, Wilhelms G, Morgner A, Wigginghaus B, Stolte M |title=''Boswellia serrata'' extract for the treatment of collagenous colitis. A double-blind, randomized, placebo-controlled, multicenter trial |journal=International Journal of Colorectal Disease |volume=22 |issue=12 |pages=1445–51 |date=Dec 2007 |pmid=17764013 |doi=10.1007/s00384-007-0364-1 |s2cid=206966118 }}</ref><ref>{{cite journal |vauthors=Wildt S, Munck LK, Vinter-Jensen L, Hanse BF, Nordgaard-Lassen I, Christensen S, Avnstroem S, Rasmussen SN, Rumessen JJ |title=Probiotic treatment of collagenous colitis: a randomized, double-blind, placebo-controlled trial with ''Lactobacillus acidophilus'' and ''Bifidobacterium animalis'' subsp. ''lactis'' |journal=Inflammatory Bowel Diseases |volume=12 |issue=5 |pages=395–401 |date=May 2006 |pmid=16670529 |doi=10.1097/01.MIB.0000218763.99334.49 |s2cid=870587 }}</ref><ref>{{cite journal |vauthors=Tromm A, Niewerth U, Khoury M, Baestlein E, Wilhelms G, Schulze J, Stolte M |title=The probiotic ''E. coli'' strain Nissle 1917 for the treatment of collagenous colitis: first results of an open-label trial |journal=Zeitschrift für Gastroenterologie |volume=42 |issue=5 |pages=365–9 |date=May 2004 |pmid=15136935 |doi=10.1055/s-2004-812709 |s2cid=3010852 }}</ref>

==Epidemiology==
One epidemiological study done on data from [[Olmsted County, Minnesota]] reported previous incidence rates found in the literature as ranging from 0.6 per 100,000 person-years (based on French data from 1987–1992) to 5.2 per 100,000 person-years (from an Icelandic study based on data from 1995-1999), while the authors themselves found an incidence rate of 3.1 per 100,000 person years in Olmsted County across the entire period 1985-2001. Based only on the subset of the data from 1998-2001, however, the authors found a higher rate of 7.1 per 100,000 person-years, an incidence rate which exceeded those of Crohn's disease and ulcerative colitis.<ref name="PardiLoftus2007">{{cite journal | last=Pardi | first=D. S | last2=Loftus | first2=E. V | last3=Smyrk | first3=T. C | last4=Kammer | first4=P. P | last5=Tremaine | first5=W. J | last6=Schleck | first6=C. D | last7=Harmsen | first7=W S. | last8=Zinsmeister | first8=A. R | last9=Melton | first9=L J. | last10=Sandborn | first10=W. J | title=The epidemiology of microscopic colitis: a population based study in Olmsted County, Minnesota | journal=Gut | publisher=BMJ | volume=56 | issue=4 | date=2007-04-01 | issn=0017-5749 | doi=10.1136/gut.2006.105890 | pages=504–508}}</ref> The previously mentioned Icelandic study also found increasing rates through the studied period, with the incidence rate in Iceland increasing from 2.2 in 1995 to 8.3 in 1999.<ref name="Agnarsdottir2002">{{cite journal | last=Agnarsdottir | first=Margret | last2=Gunnlaugsson | first2=Olafur | last3=Orvar | first3=Kjartan B. | last4=Cariglia | first4=Nick | last5=Birgisson | first5=Sigurbjorn | last6=Bjornsson | first6=Sigurdur | last7=Thorgeirsson | first7=Thorgeir | last8=Jonasson | first8=Jon Gunnlaugur | title= | journal=Digestive Diseases and Sciences | publisher=Springer Science and Business Media LLC | volume=47 | issue=5 | year=2002 | issn=0163-2116 | doi=10.1023/a:1015058611858 | pages=1122–1128}}</ref> Women appear to be more frequently affected by collagenous colitis than men, with the Icelandic study finding a female-male ratio of 7.9 in diagnosed cases and the Olmested County study finding a female-male ratio of 4.4.<ref name="PardiLoftus2007" /><ref name="Agnarsdottir2002" />


==References==
==References==

Revision as of 13:11, 30 October 2023

Collagenous colitis
Micrograph of collagenous colitis. H&E stain.
SpecialtyGastroenterology

Collagenous colitis is an inflammatory condition of the colon. Together with the related condition lymphocytic colitis, it is a subtype of microscopic colitis, which is sometimes considered to be an inflammatory bowel disease along with Crohn's disease and ulcerative colitis.[1][2] Collagenous colitis is characterized by inflammation that specifically affects the colon (i.e. colitis), and a clinical presentation that involves watery diarrhea but a lack of rectal bleeding. The peak incidence is in the 5th decade of life, and women more are more frequently affected than men.[1]

Signs and symptoms

Collagenous colitis causes chronic watery diarrhea with increased stool frequency. Some patients report nocturnal diarrhea, abdominal pain, bowel urgency, fecal incontinence, fatigue, dehydration and weight loss. Patients report a significantly diminished quality of life.[1][3]

Causes

The cause of collagenous colitis is unknown. A connection with autoimmune disorders such as celiac disease is suspected, as up to 40% of patients with collagenous colitis have an autoimmune disease. Use of nonsteroidal anti-inflammatory drugs (NSAIDs), proton pump inhibitors (PPIs) and beta blockers also appear to increase the risk of collagenous colitis, but the cause of this is not known.[1]

Diagnosis

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 also typically normal.[3]

Treatment

First line treatment for collagenous colitis is the use of budesonide, a steroid that works locally in the colon and is highly cleared by first pass effect. Other medications that can be used include the following:[1][3]

Pilot-scale studies have shown some evidence of possible benefit for both Boswellia serrata extract and specific strains of probiotics in the treatment of collagenous colitis, although larger sample sizes are needed to confirm the results.[4][5][6]

Epidemiology

One epidemiological study done on data from Olmsted County, Minnesota reported previous incidence rates found in the literature as ranging from 0.6 per 100,000 person-years (based on French data from 1987–1992) to 5.2 per 100,000 person-years (from an Icelandic study based on data from 1995-1999), while the authors themselves found an incidence rate of 3.1 per 100,000 person years in Olmsted County across the entire period 1985-2001. Based only on the subset of the data from 1998-2001, however, the authors found a higher rate of 7.1 per 100,000 person-years, an incidence rate which exceeded those of Crohn's disease and ulcerative colitis.[7] The previously mentioned Icelandic study also found increasing rates through the studied period, with the incidence rate in Iceland increasing from 2.2 in 1995 to 8.3 in 1999.[8] Women appear to be more frequently affected by collagenous colitis than men, with the Icelandic study finding a female-male ratio of 7.9 in diagnosed cases and the Olmested County study finding a female-male ratio of 4.4.[7][8]

References

  1. ^ a b c d e Park, Tina; Cave, David; Marshall, Christopher (2015-08-07). "Microscopic colitis: A review of etiology, treatment and refractory disease". World Journal of Gastroenterology. 21 (29): 8804–8810. doi:10.3748/wjg.v21.i29.8804. ISSN 1007-9327. PMC 4528022. PMID 26269669.
  2. ^ Jegadeesan R, Liu X, Pagadala MR, Gutierrez N, Butt M, Navaneethan U (2013). "Microscopic colitis: is it a spectrum of inflammatory bowel disease?". World J Gastroenterol. 19 (26): 4252–6. doi:10.3748/wjg.v19.i26.4252. PMC 3710430. PMID 23864791.{{cite journal}}: CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link)
  3. ^ a b c O’Toole, Aoibhlinn (2016-02-10). "Optimal management of collagenous colitis: a review". Clinical and Experimental Gastroenterology. 9: 31–39. doi:10.2147/CEG.S67233. ISSN 1178-7023. PMC 4754103. PMID 26929656.
  4. ^ Madisch A, Miehlke S, Eichele O, Mrwa J, Bethke B, Kuhlisch E, Bästlein E, Wilhelms G, Morgner A, Wigginghaus B, Stolte M (Dec 2007). "Boswellia serrata extract for the treatment of collagenous colitis. A double-blind, randomized, placebo-controlled, multicenter trial". International Journal of Colorectal Disease. 22 (12): 1445–51. doi:10.1007/s00384-007-0364-1. PMID 17764013. S2CID 206966118.
  5. ^ Wildt S, Munck LK, Vinter-Jensen L, Hanse BF, Nordgaard-Lassen I, Christensen S, Avnstroem S, Rasmussen SN, Rumessen JJ (May 2006). "Probiotic treatment of collagenous colitis: a randomized, double-blind, placebo-controlled trial with Lactobacillus acidophilus and Bifidobacterium animalis subsp. lactis". Inflammatory Bowel Diseases. 12 (5): 395–401. doi:10.1097/01.MIB.0000218763.99334.49. PMID 16670529. S2CID 870587.
  6. ^ Tromm A, Niewerth U, Khoury M, Baestlein E, Wilhelms G, Schulze J, Stolte M (May 2004). "The probiotic E. coli strain Nissle 1917 for the treatment of collagenous colitis: first results of an open-label trial". Zeitschrift für Gastroenterologie. 42 (5): 365–9. doi:10.1055/s-2004-812709. PMID 15136935. S2CID 3010852.
  7. ^ a b Pardi, D. S; Loftus, E. V; Smyrk, T. C; Kammer, P. P; Tremaine, W. J; Schleck, C. D; Harmsen, W S.; Zinsmeister, A. R; Melton, L J.; Sandborn, W. J (2007-04-01). "The epidemiology of microscopic colitis: a population based study in Olmsted County, Minnesota". Gut. 56 (4). BMJ: 504–508. doi:10.1136/gut.2006.105890. ISSN 0017-5749.
  8. ^ a b Agnarsdottir, Margret; Gunnlaugsson, Olafur; Orvar, Kjartan B.; Cariglia, Nick; Birgisson, Sigurbjorn; Bjornsson, Sigurdur; Thorgeirsson, Thorgeir; Jonasson, Jon Gunnlaugur (2002). Digestive Diseases and Sciences. 47 (5). Springer Science and Business Media LLC: 1122–1128. doi:10.1023/a:1015058611858. ISSN 0163-2116. {{cite journal}}: Missing or empty |title= (help)
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