A study of Collagenous Colitis and its Treatment

Post by **tex** » Tue Jun 21, 2005 3:18 pm

Linköping University Medical Dissertations
No. 486
Collagenous colitis
A study of epidemiology, etiology, clinical features and treatment
Johan Bohr
Akademisk avhandling som för avläggande av medicine doktorsexamen kommer att offentligt försvaras i Wilandersalen, Regionsjukhuset, Örebro, fredag den 19 april 1996, kl. 13.00.
Opponent: Docent Robert Löfberg, Institutionen for Medicin, Karolinska Institutet, Huddinge Sjukhus.
ABSTRACT

Collagenous colitis (CC) is characterised clinically by chronic watery diarrhoea and histopathologically by an increased submucosal collagen layer. An epidemiologic study of CC during 1984 to 1993 showed a female:male ratio of 9:1. The median age at diagnosis was 64 (28-78) years. The prevalence was 15.7/105 on December 31, 1993, and the mean annual incidence was 1.8/105 inhabitants. Age specific incidence showed a peak of 14.6/105 in females 70-79 years old, which approaches the incidence for ulcerative colitis in the same age group.
Faecal stream diversion in 9 patients with severe, medically intractable CC induced histologic and clinical remission. This observation indicates that a noxious agent in the faecal stream constitutes an etiologic factor in CC. Faecal stream diversion offers a treatment alternative in patients with severe CC who do not respond to medical treatment.
Sera from 38 patients with CC and matched controls were analysed for specific autoantibodies, immunoglobulins and complement. The mean value of IgM was significantly increased in patients; 2.5 g/L compared to 1.4 g/L in controls (p=0.002). ANA and pANCA occurred more frequently in patients, although the difference did not reach statistical significance. The results of all other immunoglobulins, complement factors, and specific antibodies were similar in patients and controls. The findings of an increased IgM level in patients, might give some support to a hypothesis of autoimmunity in CC. The ANA- and pANCA positive patients could constitute a subpopulation among CC patients.
Procollagen III propeptide (P-III-NP) is a product of collagen III metabolism. No significant difference between the serum level of P-III-NP in 38 patients (3.8±2.0 µg/L) and 38 matched controls (3.7±1.3 µg/L) was found, and P-III-NP did not correlate to clinical activity. There was a significant correlation, however, between P-III-NP and age in both patients and controls. The study showed that colonoscopy is still required to diagnose CC and cannot be replaced, at present, by a simple blood test.
A register of patients with CC was set up at the Örebro Medical Center Hospital. Twenty five Swedish hospitals contributed with patient records to this register which comprised of data from 163 patients. Data showed that CC usually followed a chronic intermittent benign course. The onset was sudden in up to 42% of the patients. The most common symptoms were chronic watery diarrhoea, sometimes nocturnal, abdominal pain and weight loss. Routine laboratory data were most often normal.
Evaluation of the treatment showed a response rate of 59% for sulphasalazine, and 40% respectively 50% for olsalazine and mesalazine. Prednisolone was effective in about 80% of the patients, but the required dosage was often high, and the effect not sustained after withdrawal. Metronidazole, erythromycin and penicillin had response rates from 55% to 100%. Cholestyramine and loperamide offer treatment alternatives of which about two thirds of the patients benefit.
Department of Internal Medicine
Linköping University, S-581 85 Linköping, Sweden
and
Department of Medicine, Division of Gastroenterology
Örebro Medical Center Hospital, S-701 85 Örebro, Sweden
Linköping 1996
ISBN 91-7871-343-9 ISSN 0345-0082

koksvik · Post by **koksvik** » Sun Dec 20, 2015 3:12 am

Hi Tex,

I was pleased to see you referring to some of the work that is being done in Sweden.
------------------
Linköping University Medical Dissertations
No. 486
Collagenous colitis
A study of epidemiology, etiology, clinical features and treatment
Johan Bohr
Akademisk avhandling som för avläggande av medicine doktorsexamen kommer att offentligt försvaras i Wilandersalen, Regionsjukhuset, Örebro, fredag den 19 april 1996, kl. 13.00.
Opponent: Docent Robert Löfberg, Institutionen for Medicin, Karolinska Institutet, Huddinge Sjukhus.
-------------------------

Here is another article from the same team that sums up what the current (2011) status is on MC. I hope you find it interesting.

Rolf

Lilja · Post by **Lilja** » Sun Dec 20, 2015 3:52 am

Rolf,
Did you forget to include the link?

Lilia

koksvik · Post by **koksvik** » Sun Dec 20, 2015 4:47 am

Lilia,

Yes I did, maybe it is Alzheimer light. Thanks for being so observant. Here it is:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3959332/

By the way, there is a lot of interesting stuff coming out of Örebro, but as much of it is in Swedish it makes no sense for me to point it out. However, you can read Swedish so you might want to look up what is going on. "Söta bror" has got a lot going for him.

Rolf

Lilja · Post by **Lilja** » Sun Dec 20, 2015 5:58 am

Thank you for the link, Rolf.

Now, this is interesting and something Tex has pointed out several times:

"Generally, the histopathologic changes are restricted to the large bowel, but a thickened collagen layer has infrequently been found in the stomach, duodenum, or terminal ileum. "

Lilia