Polly - Here's That Article That I Was Trying To Find

[tex]

This is the article that supports my claim that MC patients often "segue" from one "form" to the other, (that is, from CC to LC, for example), and that MC is, in fact, a single disease, and not two or three, or more, related diseases:

Early literature suggested that CC and LC differed slightly in their clinical presentation and disease course. Both present with watery, nonbloody diarrhea and may be associated with other conditions including connective tissue disorders, autoimmune diseases, and celiac sprue. However, CC was initially reported to afflict mostly older women in the sixth and seventh decades, whereas LC was thought to occur equally in both genders and approximately 10 years earlier.

More recent reports have questioned this dichotomy [3]. Several patients have been observed to convert from one form of colitis to another [4, 5, 6, 7], and larger case series have failed to confirm differences in gender distribution [2, 8], age at presentation [2, 9, 10*], or prognosis [11]. Furthermore, long-term follow-up studies suggest that about 50% of patients initially diagnosed to have CC subsequently convert to LC [11], a finding that may in part reflect the patchy distribution of the thickened collagen band [12, 13, 14]. Indeed, close scrutiny of biopsy specimens suggests that the morphology of the microscopic colitides lies along a continuous spectrum and that there is substantial overlap between the CC and LC [15, 16*].

That quote is from this site:

http://www.treatment-options.com/articl ... pe=Article

Note that the article is very,very well documented. I don't believe that this in any way contradicts what Dr. Fine says on his site. In fact, the way I interpret what Dr. Fine has to say about it, apparently differs from your interpretation, (and Mike's), and this article merely expands on what Dr. Fine says, and clarifies the facts, to remove any ambiguity. I'm hoping that I can "rest my case", with this one. LOL.

Love,
Tex

[Mars]

This isn't relative, but maybe it is..............

My doctor INSISTS that you can have MC and IBS/IBD at the same time??? Is this so???

Just curious because I have symptoms of all of them if you look them up separately. I realize that MC is misdiagnosed because of the similarity of symptoms but can you have two or more?

Just curious

Love,
Mars

[tex]

Hi Mars,

IMO, sure it is, (both relative and possible). There is nothing about MC that makes us immune to any other disease, and accordingly, I see no reason why anyone with MC cannot have any other disease at the same time, (or before or after, for that matter). I think that in most cases, when a doctor searching for a diagnosis, finds a likely candidate, he or she usually stops looking, after confirming a diagnosis that seems to match the symptoms.

If Crohn's disease were diagnosed, for example, and MC were present, the MC would almost surely get lost in the shuffle. Likewise, if MC is diagnosed, the IBS is probably oing to be overlooked/forgotten.

Love,
Tex

[Mars]

Ok, I have been diagnosed with IBS (for years......since a kid) and I believe I've also been diagnosed with IBD???? I also have MC (CC)! It's depressing when you think of all the problems I have - I should be 80 years old! hahaha

As my grammy used to say...........Margie, you're just a pain in the arse!" She ment that lovingly because of all the arse problems I have!!!

Thanks for you opinion - I agree, just wanted validation I guess! teehee.

Love,
Mars

[Polly]

Hi All!

Mars Bar, you do indeed have IBD (inflammatory bowel disease), as do all of us here! MC is considered to be one of the IBDs, albeit not as severe as IBDs like Crohn's. Like you and Tex, I believe that it is possible to have both IBD and IBS at the same time.

Tex, I am still confused about the point you are trying to make. LOL! I am so dense sometimes! At first I thought that you were theorizing that anyone with MC would have both of the biopsy findings at the same time. IOW, if enough biopsies were taken from one person, then areas with collagen (CC) would be found as well as areas with no collagen (LC). But this is not what your reference says. If I am reading it correctly, it talks about a "continuous spectrum", which to me means that there will be people with MC who have ONLY the findings of LC on biopsy (lymphocytes), people with only the findings of CC on biopsy (lymphocytes and collagen), and an overlap area in the middle where the findings of both LC and CC may be found in the same person. I picture this as a Venn diagram, with the overlap area in the center of two intersecting circles.

I do believe that one form can segue into another and that it may be possible to miss areas of collagen bands if they are patchy. However, IMHO, it is possible for a single person to have biopsy findings of ONLY LC or ONLY CC.

It is like the celiac/gluten sensitivity issue. In reality they may be the same disease with similar genetics and the same treatment, but on clinical tests the findings are different (positive blood test in celiac but not in gluten sensitivity). Similarly, LC and CC are both under the umbrella of MC and seem to be the same disease with the same treatment, but on clinical tests (biopsies) they show up differently.

Love,

Polly

P.S. I can't seem to find any comments on Dr. Fine's website about one form seguing into another. In the section on MC/LC/CC, he mentions the criteria for diagnosing either LC or CC - that both have lymphocytes but that CC additionally has collagen. And he makes the point that LC was never appropiately named, since CC also has lymphocytes. I suggested in an earlier post that he would probably rename the two forms CC (collagenous colitis) and NCC (non-collagenous colitis). LOL! It would certainly help to clarify the original misnomer of LC.

[tex]

Hi Polly,

Sorry. I realize that I sometimes commit so much mayhem with syntax. that it becomes difficult to pinpoint what my main point actually might be. LOL. My main point is in my first sentence in that post, (in red, in the following quote):

This is the article that supports my claim that MC patients often "segue" from one "form" to the other, (that is, from CC to LC, for example), and that MC is, in fact, a single disease, and not two or three, or more, related diseases:

I don't believe that Dr. Fine mentions anything about one form of MC changing to another form, on his website, and the reason that he doesn't mention it, is probably because he realizes that it's irrelevant, for reasons that I will describe in the following paragraphs. What he does say is, "These are three terms used to describe essentially the same syndrome. Microscopic colitis is the most general term and the one I prefer." Notice his choice of words, "essentially the same syndrome". And when you read his discussion, you will note that he only uses the term MC, (not CC and /or LC). I think that if he had his druthers, there would be no diagnoses of CC, and/or LC. There would be only MC.

That's my point. There's only one disease here - MC. The fact that it sometimes can be diagnosed in different ways, doesn't really matter, does it? The clinical symptoms are the same, and the treatment is the same, in all cases. If it quacks like a duck, and has diarrhea like a duck, etc., etc.

Look at the common cold. It can be a head cold, with a stuffy nose, and watery eyes, or it can be a chest cold, with congested bronchial tubes, etc, and one type can segue to the other. It can be caused by a rinovirus, adenovirus, or coronavirus. That's much more variability than is involved with MC, but the condition is still called a cold. If we don't need to distinguish between the different types of what we call a "cold", then why would we need to distinguish between different types of MC?

IOW, the fact that MC segues from one form to another, is irrelevant, because it's still the same disease - the basic clinical symptoms haven't changed, nor has the treatment. Once you recognize that fact, then a lot of the unnecessary and complicated relationships that are involved with this disease, become irrelevant.

Regarding your observation:

It is like the celiac/gluten sensitivity issue. In reality they may be the same disease with similar genetics and the same treatment, but on clinical tests the findings are different (positive blood test in celiac but not in gluten sensitivity).

Here again, is there any logical reason to believe that this is not the same disease? The cause is the same, the symptoms are the same, and the treatment is the same. (It's hard ot keep from adding the phrase "well duh!", at this point). The fact that the medical profession chooses to diagnose them differently, will eventually have to be corrected, and brought into compliance with reality. After all, a diagnosis for gluten sensitivity will catch all celiacs, in the process. Will it not?

The defining marker in a celiac diagnosis is villous atrophy, but even this has been shown to be present in many cases that were missed by the blood tests, and if I remember correctly, some celiacs don't present with significant villous atrophy, even though they test positive to the blood test. Even though classic celiac disease and gluten sensitivity may affect the digestive system in different ways, the results are the same, as far as morbidity and general health are concerned, and the treatment is the same. The definition of celaic disease needs to be changed, and the current accepted standard for diagnosing celiac disease needs to be upgraded to catch all gluten sensitive individuals.

Sorry to get off on a tangent. LOL.

Love,
Tex

[Polly]

Hi again Tex,

AHA! We are in complete agreement. Amazing that it took us so long to figure it out! LOL!

Yes, LC and CC are both considered to be MC and should receive the same treatment. However, it may be premature to discontinue the separate biopsy designations at present, as they may have some predictive value in the future. It would be interesting to see what a large, prospective study that looked at ALL of the variables would find. Even in the article you cited, in the pharmacology section under aminosalicylates, it states that sulfasalazine and 5-ASA are useful for both CC and LC, but that LC may be more responsive. And I still think that LC responded more quickly to the GF diet in our early experience on Sally's board. Time will tell, I suppose...............IF more researchers get interested in MC, that is.

Love,

Polly, who always enjoys our stimulating discussions

[tex]

Polly,

Great!

Okay, now to get to the problems with the article that I cited: First off, I notice that the article begins with some "Opionion Statements", and the second one claims:

Nonspecific antidiarrheal agents (eg, loperamide, diphenoxylate) may be administered, but appear to be largely ineffective in this population.

And yet, in this study, loperamide is given a response rating of 71%, which would put it at the upper end of the list of beneficial meds, (in fact, it was only bested by prednisolone, at 82%, (all of these articles were apparently written before budesonide had been researched and accepted as a treatment for MC):

http://www.unboundmedicine.com/medline/ ... 3_patients

Incidentally, when I looked up microscopic colitides, (to see if there were any other diseases in that category besides MC), I came across this old article. Notice the main author, and notice how promising the treatment appeared in that article, with an 85% success rate, no side effects, and of the 85% who achieved remission, 82% remained in remission, (with no mention of diet). This was published in February, 1999, and already the finger of suspicion was pointing at bacteria, (or some other immunostimulating agents).

http://www.blackwell-synergy.com/links/ ... 535.x/abs/

I think that the reason why LC seems to be more responsive to treatment, is because it is more responsive, and that phenomenon is related to the Paneth cell metaplasia statistics. IOW, a much higher percentage of patients diagnosed with CC, present with Paneth cells in the epithelium of their colon, which would seem to indicate that those patients' immune systems perceive a much greater threat to the well-being of the body, than those where the Paneth cells do not exist, (mostly LC patients). Presumably, if the body perceives a greater threat, then a greater threat actually exists, and whatever that threat might be, serves to impede the treatment for patients in that classification, (mostly CC patients).

Love,
Tex

P S Hey, I thoroughly enjoy these discourses also, and whether we actually accomplish anything or not, they at least stimulate a lot of thought, and more research.

[Dee]

I've been reading these posts with great interest!
Being one diagnosed with collageous colitis, I have to admit that Wayne's statement about patients with CC immune systems perceive a much greater threat to the wll being of their bodies, kinda scares me.. Not knowing what kind of threat is the question.
Soooo, I pulled out my biopsy report..
Here it goes:
Sections consist of 3 fragments of colonic mucosa, showing overall well preserved crypt architecture. The surface epithelium is focally sloughed off. The surface & the crypt epithelium demonstrates increased number of lymphocytes an occasional neutrophils (cryptitis). No definite ulceration or crypt abscess formation is noted. No granulomas are seen. The lamina propria is extended by chronic inflammatory cell infiltrate and focal small lymphoid aggregates. Trichrome stain demonstrates focal mild increased thickness of the subepithelaial collagen layer. (15-20 microns).
Can't wait to have this analyzed!!!!

Love
Dee~~~~~

[tex]

Dee,

You're looking good. There's nothing in that pathology report to be concerned about, (except for the markers of CC, of course, and your markers are actually rather mild).

I apologize, since I didn't mean to scare anyone with that remark about the immune systems of CC patients perceiving a greater threat to the well being of their bodies. I was merely justifying the presence of the paneth cells in the colonic mucosa of a fairly high percentage of CC patients. They shouldn't be there, of course, and their presence suggests that they might be there because the body feels the need for them as a defense mechanism, (they're normally found in the small intestine, but not in the colon.

Your report doesn't mention the presence of any Paneth cells, so presumably, there were none in your biopsy samples. Even if there were, though, that doesn't mean that there's any reason to be concerned. The Paneth cells in the colons of CC patients, are always benign, as far as I'm aware.

Love,
Tex

[Dee]

Hi Wayne!!
WHEWWWW!!
Your explanation gives me something to about!!!! LOL!!!!

Love
Dee~~~~~

[harvest_table]

This is an interesting study mentioning paneth cells.

I've wondered why some of us have pain and some don't. I was DX with CC and have not experienced pain like symptoms like many here. Paneth cells, based on this study seem to go along with MC'rs that more often experience abdominal pain.

http://www.ncbi.nlm.nih.gov/entrez/quer ... t=Abstract

[tex]

Hi Joanna,

Thanks for the link. Yes, the paneth cells seem to be present in cases with the more severe symptoms. I'm not sure that anyone knows why, at this point.

Love,
Tex

[thedell19]

Tex-

great article. I agree that you can have MC, LC, IBS, IBD or any combo at the same time. I personally found that when I was in a flare I would get really stressed out about not getting better and that in turn would make me sicker. Well we all know stress plays a part in IBS- and there is a history of IBS in my family and possible gluten intolerance, celiac sprue etc because I have both of the genes needed in order to have celiac sprue. Our bodies are all so different- and yet amazingly they are the same (if that makes any sense). We can all share the same "disease"yet have different symptoms, different times of remission, different effective treatments regimens etc.