Collagenous colitis

Collagenous colitis
Micrograph of collagenous colitis. H&E stain.
Classification and external resources
DiseasesDB	2955
eMedicine	med/1351
MeSH	D046729

Collagenous colitis is an inflammatory bowel disease affecting the colon specifically 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.

Signs and symptoms

Microscopic colitis causes watery intermittent diarrhea with greater than 10 bowel movements per day. Some patients report nocturnal diarrhea, abdominal pain, vomiting, chills, severe nausea, dehydration and weight loss. Rare complications may include mucosal atrophy with long standing collagenous colitis. Colitis patients report a significantly diminished quality of life.

Causes

The exact cause of collagenous colitis is unknown.

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 typically normal.

Treatment

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

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.^[1]^[2]^[3]

References

↑ 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.". Int J Colorectal Dis. (22(12):2): 1445–51. doi:10.1007/s00384-007-0364-1. PMID 17764013.
↑ 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.". Inflamm Bowel Dis. (12(5)): 395–401. doi:10.1097/01.MIB.0000218763.99334.49. PMID 16670529.
↑ 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.". Z Gastroenterol. (42(5)): 365–9. doi:10.1055/s-2004-812709. PMID 15136935.

personal experience with disease

Chande N, Driman DK, Reynolds RP (March 2005). "Collagenous colitis and lymphocytic colitis: patient characteristics and clinical presentation". Scand. J. Gastroenterol. 40 (3): 343–7. doi:10.1080/00365520510011623. PMID 15932175.
Yen E. F., Pardi D. S. (May 2011). "Microscopic Colitis – Lymphocytic, Collagenous and ‘Mast Cell’ Colitis". Alimentary Pharmacology & Therapeutics 34 (1): 21–32. doi:10.1111/j.1365-2036.2011.04686.x.
Majores Michael, Wunsch Steffen, Blume Bernd, Fischer Hans-Peter, and Reichel Christoph (October 2011). "Mucosal Atrophy in Collagenous Colitis: A Case Report" 11 (114). doi:10.1186/1471-230X-11-114.
Milman Nataliya, Kraa Gunnar (2010). "NSAID-induced Collagenous Colitis". The Journal of Rheumatology 37 (11): 2432–243. doi:10.3899/jrheum.100573.

Diseases of the digestive system (primarily K20–K93, 530–579)

Upper GI tract

Esophagus	Esophagitis Candidal Eosinophilic Herpetiform Rupture Boerhaave syndrome Mallory-Weiss syndrome UES Zenker's diverticulum LES Barrett's esophagus Esophageal motility disorder Nutcracker esophagus Achalasia Diffuse esophageal spasm Gastroesophageal reflux disease (GERD) Laryngopharyngeal reflux (LPR) Esophageal stricture Megaesophagus

Stomach	Gastritis Atrophic Ménétrier's disease Gastroenteritis Peptic (gastric) ulcer Cushing ulcer Dieulafoy's lesion Dyspepsia Pyloric stenosis Achlorhydria Gastroparesis Gastroptosis Portal hypertensive gastropathy Gastric antral vascular ectasia Gastric dumping syndrome Gastric volvulus

Lower GI tract:
Intestinal/
Enteropathy

Small intestine (Duodenum/Jejunum/Ileum)	Enteritis Duodenitis Jejunitis Ileitis Peptic (duodenal) ulcer Curling's ulcer Malabsorption: Coeliac Tropical sprue Blind loop syndrome Small bowel bacterial overgrowth syndrome Whipple's Short bowel syndrome Steatorrhea Milroy disease bile acid malabsorption

Large intestine (Appendix/Colon)	Appendicitis Colitis Pseudomembranous Ulcerative Ischemic Microscopic Collagenous Lymphocytic Functional colonic disease IBS Intestinal pseudoobstruction / Ogilvie syndrome Megacolon / Toxic megacolon Diverticulitis/Diverticulosis

Large and/or small	Enterocolitis Necrotizing Gastroenterocolitis IBD Crohn's disease Vascular: Abdominal angina Mesenteric ischemia Angiodysplasia Bowel obstruction: Ileus Intussusception Volvulus Fecal impaction Constipation Diarrhea Infectious Intestinal adhesions

Rectum	Proctitis Radiation proctitis Proctalgia fugax Rectal prolapse Anismus

Anal canal	Anal fissure/Anal fistula Anal abscess Anal dysplasia Pruritus ani

GI bleeding/BIS

Accessory

Liver	Hepatitis Viral hepatitis Autoimmune hepatitis Alcoholic hepatitis Cirrhosis PBC Fatty liver NASH Vascular Budd-Chiari syndrome Hepatic veno-occlusive disease Portal hypertension Nutmeg liver Alcoholic liver disease Liver failure Hepatic encephalopathy Acute liver failure Liver abscess Pyogenic Amoebic Hepatorenal syndrome Peliosis hepatis Metabolic disorders Wilson's Disease Hemochromatosis

Gallbladder	Cholecystitis Gallstones/Cholecystolithiasis Cholesterolosis Rokitansky-Aschoff sinuses Postcholecystectomy syndrome Porcelain gallbladder

Bile duct/ Other biliary tree	Cholangitis Primary sclerosing cholangitis Secondary sclerosing cholangitis Ascending Cholestasis/Mirizzi's syndrome Biliary fistula Haemobilia Gallstones/Cholelithiasis Common bile duct Choledocholithiasis Biliary dyskinesia Sphincter of Oddi dysfunction

Pancreatic	Pancreatitis Acute Chronic Hereditary Pancreatic abscess Pancreatic pseudocyst Exocrine pancreatic insufficiency Pancreatic fistula

Abdominopelvic

Hernia	Diaphragmatic Congenital Hiatus Inguinal Indirect Direct Umbilical Femoral Obturator Spigelian Lumbar Petit's Grynfeltt-Lesshaft Undefined location Incisional Internal hernia

Peritoneal	Peritonitis Spontaneous bacterial peritonitis Hemoperitoneum Pneumoperitoneum

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