Collagenous colitis

Collagenous colitis
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Field	Gastroenterology
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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 in the absence of rectal bleeding. It is often classified under the umbrella entity microscopic colitis, that it shares with a related condition, lymphocytic colitis.<ref name=":0">Park, Tina,

 Microscopic colitis: A review of etiology, treatment and refractory disease, 
 World Journal of Gastroenterology, 
 
 Vol. 21(Issue: 29),
 pp. 8804–8810,
 DOI: 10.3748/wjg.v21.i29.8804,
 PMID: 26269669,
 PMC: 4528022,</ref>

Signs and symptoms

Microscopic colitis causes chronic watery diarrhea with greater than 10 bowel movements per day. Some patients report nocturnal diarrhea, abdominal pain, urgency, fecal incontinence, fatigue, dehydration and weight loss. Patients report a significantly diminished quality of life.<ref name=":0" /><ref name=":1">O’Toole, Aoibhlinn,

 Optimal management of collagenous colitis: a review, 
 Clinical and Experimental Gastroenterology, 
 
 Vol. 9,
 pp. 31–39,
 DOI: 10.2147/CEG.S67233,
 PMID: 26929656,
 PMC: 4754103,</ref>

Causes

The cause of collagenous colitis is unknown.<ref name=":0" />

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.<ref name=":1" />

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 are the following:<ref name=":0" /><ref name=":1" />

• Bismuth agents, including Pepto-Bismol
• 5-aminosalicylic acid
• Immunosuppressants, including azathioprine
• infliximab

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>,

 Boswellia serrata extract for the treatment of collagenous colitis. A double-blind, randomized, placebo-controlled, multicenter trial, 
 International Journal of Colorectal Disease, 
 
 Vol. 22(Issue: 12),
 pp. 1445–51,
 DOI: 10.1007/s00384-007-0364-1,
 PMID: 17764013,</ref><ref>, 
 Probiotic treatment of collagenous colitis: a randomized, double-blind, placebo-controlled trial with Lactobacillus acidophilus and Bifidobacterium animalis subsp. lactis, 
 Inflammatory Bowel Diseases, 
 
 Vol. 12(Issue: 5),
 pp. 395–401,
 DOI: 10.1097/01.MIB.0000218763.99334.49,
 PMID: 16670529,</ref><ref>, 
 The probiotic E. coli strain Nissle 1917 for the treatment of collagenous colitis: first results of an open-label trial, 
 Zeitschrift für Gastroenterologie, 
 
 Vol. 42(Issue: 5),
 pp. 365–9,
 DOI: 10.1055/s-2004-812709,
 PMID: 15136935,</ref>

See also

• Colitis
• Lymphocytic colitis
• Inflammatory bowel disease
• Ulcerative colitis

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