2011 Dissertation on MICROSCOPIC COLITIS by Koskela

faithberry · Post by **faithberry** » Sun Dec 04, 2011 6:14 pm

Hi All,

Have you seen this 20 May 2011 dissertation? You probably have, but just in case. It confirms many of the points I've seen mentioned on this forum in the last few years. None of this is necessarily new news, but it's nice to see it brought together in an academic and medical presentation. The paper has much more in it. Hope you can use the link.

~

The present findings suggest that mucosal abnormalities in MC might involve
not only the colon but also ileum, gastric and duodenal mucosa.

~
According to these findings, it seems obvious that there is a remarkable
proportion of MC patients who experience a more widespread inflammatory
changes throughout the gastrointestinal channel. The common pathogenetic
mechanism behind this phenomenon is not known and no conclusion could be
drawn in the current study about how the symptoms correlate to the extensiveness
of the disease.

Patients with MC without diarrhoea and even with constipation have also been
reported (Mullhaupt et al. 1998, Olesen et al. 2004a).

An additional finding in both forms of MC is inflammation in lamina propria
dominated by lymphocytes and plasma cells (Lazenby et al. 1989). In addition,
eosinophils and mast cells may be found, but neutrophils are scanty. (MAST CELLS!)
~
This is the first study of MC evaluating the upper gastrointestinal endoscopical
and histological changes in MC and in particular, this is the first systematic analysis of gastric morphology of MC, only
case reports so far have been published of the special type of gastritis

~
According to these findings, it seems obvious that there is a remarkable
proportion of MC patients who experience a more widespread inflammatory
changes throughout the gastrointestinal channel. The common pathogenetic
mechanism behind this phenomenon is not known and no conclusion could be
drawn in the current study about how the symptoms correlate to the extensiveness
of the disease.
~
LG is a relatively common type of gastritis with a reported prevalence of
about 4–6% in gastric biopsy material (Niemela et al. 1995). In this series, the
overall prevalence of LG in MC (5.6%) did not differ from that in the controls
(10%) (Table 10). However, as in previous studies, LG was found only in LC and
no cases were detected in CC (Wu & Hamilton 1999).

~

The present findings suggest that mucosal abnormalities in MC might involve
not only the colon but also ileum, gastric and duodenal mucosa.

~

The decrease of foveolar height in the gastric body mucosa and
villous height in the duodenum in patients with MC, the latter even without
evidence of CD, points to the presence of some previously unknown links
between colorectal inflammation and the gastroduodenal mucosal structure.

Ritva Koskela

MICROSCOPIC COLITIS:
CLINICAL FEATURES AND
GASTRODUODENAL AND
IMMUNOGENETIC FINDINGS

Dissertation 20 May 2011

UNIVERSITY OF OULU, FACULTY OF MEDICINE,
INSTITUTE OF CLINICAL MEDICINE,
DEPARTMENT OF INTERNAL MEDICINE,
INSTITUTE OF DIAGNOSTICS,
DEPARTMENT OF PATHOLOGY,
DEPARTMENT OF MEDICAL MICROBIOLOGY

LINK

https://docs.google.com/viewer?a=v&q=ca ... es7JzmmEjw

In the end I've decided that MC must be fundamental to my health issues even if I don't have D. in combination with gluten-induced neuropathy and some level of systemtic inflammation and mild mast cell activation. I still haven't gotten another colonoscopy or upper endoscopy and probably should.

Best wishes to all!

Gloria · Post by **Gloria** » Sun Dec 04, 2011 9:12 pm

Thanks for posting this, Faith.

Gloria

Lesley · Post by **Lesley** » Sun Dec 04, 2011 9:48 pm

Patients with MC without diarrhoea and even with constipation have also been reported (Mullhaupt et al. 1998, Olesen et al. 2004a).

WOW! Faith thank you. Something I can take with me to show those neanderthals docs that I do NOT have MC AND IBS.
This is fantastic. Good to know.

Post by **tex** » Sun Dec 04, 2011 11:40 pm

Lesley,

If you want to prove that MC can be associated with constipation, here's a reference that I'm citing in my book:

AIM: To evaluate the relationship between symptoms and microscopic colitis (MC) subtypes: to test whether collagenous colitis (CC) and/or lymphocytic colitis (LC) might be related to both constipation and diarrhea.

Here is the report in full:

http://www.wjgnet.com/1007-9327/11/1351.pdf

This is also why I believe that Entocort will help you to achieve remission.

Tex

faithberry · Post by **faithberry** » Mon Dec 05, 2011 5:25 pm

You're welcome Lesley and Gloria! I was amazed by the report that people with MC even without Celiac Disease tend to have shorter villi. Perhaps you've see that before since naturally a dissertation contains an overview of the literature.

Wishing you well!

Lesley · Post by **Lesley** » Mon Dec 05, 2011 5:32 pm

Thanks Tex. It's bookmarked.

I am not sure how much entocort I should take. Starting with 6 mgs and go from there?

Does anyone know how long they should take to help?

I would love to be able read the entire dissertation. I don't know why I can't.

Post by **tex** » Mon Dec 05, 2011 7:23 pm

Lesley wrote:I am not sure how much entocort I should take. Starting with 6 mgs and go from there?

That's a good question. Normally, most people are better off with the full dose. I mentioned the option of taking either 6 mg or 9 mg, since C is a problem. According to the label, 9 mg is a therapeutic dose, and 6 mg is a maintenance dose. We have a couple of members who are so sensitive to it that they can never take more than 3 mg, without serious side effects, and 3 mg is very effective for them.

Corticosteroids are at their best, in general, when they're started at the maximum dose, and then tapered, because it takes a certain minimum level to be effective, and at 9 mg per day, that level is usually not going to be reached for a few days, but once the level is reached, then a lower dosage may be adequate, as the body utilizes the residual supply. IOW, you might reach remission faster if you take the full dose for a few days, and then try dropping to 6 mg. Your body will tell you whether you need to go back to 9 mg, or whether 6 mg is still too much.

If you prefer to be cautious, (because of the risk of making the C worse), you might try 6 mg per day for a week, and see what it does.

Lesley wrote:Does anyone know how long they should take to help?

If you're lucky, you should start seeing some improvement in a week or two.

Tex

LindyLou · Post by **LindyLou** » Mon Dec 05, 2011 7:36 pm

Thank you so much for posting this Faith. I just found out my BP meds are a no no! Will be calling the doctor tomorrow morning.

Lesley · Post by **Lesley** » Mon Dec 05, 2011 11:12 pm

OK, tomorrow I will take 9 mgs.

I took 2 stool softeners last night. Still no action. Tonight I will take 3, although that also scares me.
That's one BM in 7 days. The bloating is outrageous.

I don't seem to be able to get enough protein. I just cant eat that much. I can't cut out potatoes and only eat meat. They seem to help calm the GERD.
I don't know how to eat any more.

Lesley · Post by **Lesley** » Tue Dec 06, 2011 11:48 am

I wish I could read that dissertation! For some reason I can't open it.

Post by **tex** » Tue Dec 06, 2011 1:28 pm

It's a PDF file. You may need to download an updated version of Adobe Reader, or some other PDF interpreter.

Tex

Sheila · Post by **Sheila** » Tue Dec 06, 2011 7:53 pm

Lesley, if you are already experiencing C, 9 mg of entocort will make that worse. I had full blown D, took 3 entocort and didn't go at all for days. I cut back to 1 a day and have no problems with either D or C. I'm GF, SF, DF. My mother also had MC and stopped taking entocort because of problems with C. She refused to cut back on the prescribed 9 mg a day. Stubborn lady. She stopped taking it and got the D back big time. When she began to take it again, it just didn't work as well. She stopped taking it again and had D for the rest of her life. I don't experience any side effects

and will take it forever if necessary.
Sheila

Lesley · Post by **Lesley** » Tue Dec 06, 2011 10:00 pm

Tex,
I have Adobe, and read a lot of PDF files. I don't know why I can get the first 2 pages of it, but the rest is just blank pages.

I decided to take 6 mg after consultation with Tex, to try to get the inflammation under control. Nothing else is helping. I am also taking numerous stool softeners. Tonight there is some gurgling and pressure. Who knows? I might get lucky? Maybe Norman will visit me?

Post by **tex** » Tue Dec 06, 2011 10:25 pm

Lesley,

Regarding the article, does your browser show a separate scrollable frame on the left side for that dissertation? You should be able to scroll down in that frame to any page you want, (there are 116), and click on the one you want, and it should show up. Maybe that will work, if scrolling down the main frame doesn't work.

Did you allow enough time - maybe it's just slow to load?

Tex