A Few Interesting Articles About Collagenous Colitis

[MBombardier]

I was looking at an article that Naty posted, and decided to do some looking around on the Wiley Online Library site. I found a couple of interesting articles:

http://onlinelibrary.wiley.com/doi/10.1 ... 96.fe/full This is dated August, 2005.

This is a letter to the editor entitled "Lymphoproliferative Disorders in Collagenous Colitis." This in particular caught my eye:

Collagenous colitis, however, is a relatively ‘‘new’’ clinical and pathologic entity that has been intimately linked to celiac disease, a disorder complicated by an increased lifetime risk of lymphoma.

Granted, this risk is low, but apparently noteworthy.

The two references for this sentence are:

http://www.ncbi.nlm.nih.gov/pubmed/15319648 entitled "Collagenous colitis as the presenting feature of biopsy-defined celiac disease. The conclusion is:

This study indicates that collagenous colitis may be the presenting clinical and pathologic feature of celiac disease. Diagnosis of collagenous colitis should lead the clinician to consider exclusion of underlying occult celiac disease.

I was surprised and dismayed to read also:

Autoimmune thyroid disease or neoplastic diseases, like lymphoma known to be associated with celiac disease were also noted in this cohort with collagenous colitis, often in the absence of celiac disease.

and

http://www.ncbi.nlm.nih.gov/pubmed/15100523 entitled "Lymphoproliferative and intestinal malignancies in 214 patients with biopsy-defined celiac disease." This one also said that:

In addition, other immune-mediated disorders, dermatitis herpetiformis, and autoimmune thyroid disease were common, suggesting a distinct clinical and pathologic phenotype in celiac disease that may predispose to malignant complications.

I have been assuming, since I have hot nodes that come and go, that I have Hashimoto's without having the test to confirm. I guess I should request that. It would be good to know if I truly have autoimmune thyroid disease or not.

[tex]

Marliss,

That's some interesting information. Remember, though, that the risk of developing lymphoma for celiacs, decreases to that of the general population, a few years after the GF diet is adopted, (assuming that the diet is strictly followed). Note that accurate compliance to the GF diet is generally very poor, and many celiacs only think that they are following a GF diet. The following quote is from a study of celiacs who supposedly had refractive sprue, (IOW), all of them were unresponsive to treatment with the GF diet:

RESULTS: A total of 55 patients were referred with a presumed diagnosis of NCD. Six did not have celiac disease and had other diseases responsible for their symptoms. Diarrhea, abdominal pain, and weight loss were the most common reasons for evaluation in cases of NCD, whereas weight loss, steatorrhea, and diarrhea were the most common presenting features of RS (nine patients). Of the 49 patients with celiac disease, 25 were identified as having gluten contamination. Additional diagnoses accounting for persistent symptoms included: pancreatic insufficiency, irritable bowel syndrome, bacterial overgrowth, lymphocytic colitis, collagenous colitis, ulcerative jejunitis, T-cell lymphoma, pancreatic cancer, fructose intolerance, protein losing enteropathy, cavitating lymphadenopathy syndrome, and tropical sprue.

http://www.ncbi.nlm.nih.gov/pubmed/12190170

Also, in the original article that you cited, this sentence raises a red flag:

In each case, celiac disease was specifically excluded by a normal small intestinal biopsy.

There is a troubling question about whether a normal small intestinal biopsy actually excludes celiac disease. Personally, I don't believe that it does, based on the recent research reports that we've seen that celiac disease can be reliably diagnosed years before small intestinal histological changes can even be detected. In fact, the Marsh scale used for rating the severity of celiac disease is not even reliable:

http://www.docguide.com/news/content.ns ... 870056180B

My point is, just because celiac disease was ruled out by obsolete methods in those three cases, does not mean that they did not actually involve celiac disease. Another thing to remember is that even if the findings of that research is correct, (that the patients had CC only), the risk of additional complications only applies to patients with unresolved symptoms. In the case of celiacs who develop such complications, it is clear from the quote that I listed above, that merely following the GF diet is not enough to guarantee a reduced risk of lymphoproliferative disorders - the diet has to be followed rigorously. This is why we always recommend getting one's symptoms under control as quickly as possible.

Thanks for the links, those are interesting references.

Tex

[MBombardier]

Thanks, Tex, I appreciate that encouragement! My original reason to post these articles was the further proof of the "intimate" connection of CC to celiac disease. However, I realized later that I had emphasized the lymphoma connection. My mother had very slow-growing Non-Hodgkins lymphoma before she died, and my father (age 87) now has to have monoclonal antibody treatment every six months to keep his NH lymphoma under control. I strongly suspect, thinking back to things when I was a kid, that my father has celiac. I have never mentioned this to him as he is pretty intimidating to talk to, and considers his lactose intolerance to be well-managed with a dose of Riopan.

I am not that worried about getting lymphoma, though seeing this information last night apparently generated some unconscious anxiety, especially since I had never seen autoimmune thyroid disease (my father is hypothyroid, too) lumped in with celiac and lymphoma like that. Knowledge is power, and we no longer have to be at the mercy of our gene expression like previous generations. That is... if we use the knowledge to our advantage, unlike the patients in the article that you cited.

Thanks again, Tex!

[hoosier1]

Marliss,

I am sorry about your mother and your father. That strikes very close to home.

My wife was part of the Phase I/II/III clinical trials for a radio-labelled monoclonal antibody treatment target for B-cell Lymphoma in the mid 90's. She became allergic to the "mouse" portion of the antibody at U of M. She actually participated in 2 of 3 clinical trials for B-cell monoclonals (another one in New Jersey). Rituxan was the first non-radiolabelled to be released, followed by more potent Bexxar and Zevalin (sp?), if memory serves. Those were some interesting days. My wife was, and still is IMO, a pioneer for having suffered through all of those trials. But it is great to hear of people actually benefiting from their release into the market. I always tell her that her efforts were not for nothing. I recall having to remain a certain distance away from her after they administered the Yttrium radio-labelled therapy due to the half life of the radiation in her body targeting the Lymphoma.

But since she had indolent (like your mother and father I presume), B-cell Non-Hodkins Lymophoma (NHL), diagnosed in 1984, they really didn't know what to do with her because at the time is was considered to be a disease of elderly men and they would simply let it run its course or try to manage it. Back then, and it could still be true today, median survival at diagnoses was 7 years.

She had become chemo-resistant, as well as resistant to the new therapies in clinical trials, so that in 1999 things were bleak. She could no longer, or never in the future, receive the new monoclonals as she developed an antibody to the mouse. The improved "humananized" monoclonals, still derived from a mouse, she could tolerate, but at the time, the radiation dosage was simply to low to be effective and since they were still in dose escalation clinical trials, they would not increase the dosage for her. Also, her disease had evolved quite a bit by this time as a result of prior therapies (typical for NHL). It was time to pull out the big guns. However, we avoided the big guns up to this point due to the extremely high mortality rate of the procedure.

So she had an allogeneic (unrelated donor) bone marrow transplant in 2000 at my favorite medical community in the world, The Cleveland Clinic. In simple terms, she has a new immune system and the blood type of her donor via a year long process and hospitalization in Cleveland. A true miracle of science, will-power, caring and intelligent doctors, a self-less donor (and now a dear friend of the family), etc.

So with NHL being autoimmune, and IBD being autoimmune, I just wonder if what they call a mini-auto or allo transplant would correct the immune deficiencies in IBD patients. I also wonder if a monoclonal antibody could be developed to target a common marker in IBD diseases so that a therapy could be more strategically applied. Time to do some google research.

Just gets me thinking.

Rich

[hoosier1]

Looks like they have found a suitable target (or are still investigating) for IBD.


http://www.medscape.com/viewarticle/725487

Thoughts?

Rich

[MBombardier]

Wow, Rich... Please thank you wife for me. How sweet to be able to do that!!!!! I will have to tell my father about her pioneering efforts.
,
I looked at the article, but I don't know enough to comment on it, other than to say that it looks promising.

I wish these were real flowers that I could give to your wife!

[hoosier1]

Marliss,

Thanks so much for the virtual flowers for my wife. She would be embarrassed to even accept them as she never felt like a hero. But obviously in my eyes, she is. Much tougher than wimpy old me.

Regards,

Rich

[natythingycolbery]

I was looking at an article that Naty posted, and decided to do some looking around on the Wiley Online Library site.

I've tried to figure out which article i posted that led you to these ones yet my brain wont function enough to make the connection

[hoosier1]

Naty,

Go back to bed. That's an order! :)

Rich

[MBombardier]

Hi Sweetie, it was the FODMAP one. Remember, this too shall pass... Hope you've gone back to bed...

[natythingycolbery]

I was asleep when you both posted that!