Adult; Age Distribution; Aged; Aged, 80 and over; Colitis/etiology/metabolism/pathology; Collagen/analysis; Female; Follow-Up Studies; Humans; Lymphocytosis/etiology/pathology; Male; Middle Aged; Prognosis; Risk Factors; Sex Distribution; Smoking/adverse effects
Abstract :
[en] BACKGROUND AND AIMS: It is not known whether lymphocytic colitis and collagenous colitis represent different clinical entities or constitute part of a spectrum of disease. METHODS: Detailed clinical features and histological findings were compared in a large series of patients with confirmed lymphocytic and collagenous colitis. RESULTS: Histological diagnosis was confirmed in 96 patients with collagenous colitis and 80 with lymphocytic colitis. Twenty eight per cent of patients with collagenous colitis and 26% of patients with lymphocytic colitis had overlapping but less pronounced histological features. Both groups were equal in terms of age, use of aspirin and non-steroidal anti-inflammatory drugs, associated autoimmune conditions, arthritis, diarrhoea, and abdominal pain. The male:female ratio was 27:73 for collagenous colitis and 45:55 for lymphocytic colitis (p=0.013). Twenty five per cent of patients with collagenous colitis compared with 14% of patients with lymphocytic colitis were active smokers; only 8.3% of patients with collagenous colitis had stopped smoking compared with 23% of patients with lymphocytic colitis (p=0.013). Drug induced disease was suspected for ticlopidine (two collagenous colitis, four lymphocytic colitis) and flutamide (four lymphocytic colitis). Mean duration of symptoms before diagnosis was two months for lymphocytic colitis and four months for collagenous colitis. Overall prognosis was generally mild; 84% of patients with lymphocytic colitis and 74% of patients with collagenous colitis reported resolution or significant improvement (p=0.033). CONCLUSIONS: Collagenous and lymphocytic colitis are similar but not identical. Patients with lymphocytic colitis present somewhat earlier and are less likely to be active smokers. Symptoms are milder and more likely to disappear in lymphocytic colitis. Ticlopidine and flutamide should be added to the list of drugs inducing colitis.
Disciplines :
Gastroenterology & hepatology
Author, co-author :
Baert, F.
Wouters, K.
D'Haens, G.
Hoang, P.
Naegels, S.
D'Heygere, F.
Holvoet, J.
Louis, Edouard ; Université de Liège - ULiège > Département des sciences cliniques > Hépato-gastroentérologie - Relations académiques et scientifiques (Médecine)
Devos, Martine ; Centre Hospitalier Universitaire de Liège - CHU > Oncologie médicale
Geboes, K.
Language :
English
Title :
Lymphocytic colitis: a distinct clinical entity? A clinicopathological confrontation of lymphocytic and collagenous colitis.
1 Bohr J, Tysk C, Eriksson S, et al. Collagenous colitis: a retrospective study of clinical presentation and treatment in 163 patients. Gut 1996;39:846-51.
2 Lazenby AJ, Yardley JH, Giardiello FM, et al. Lymphocytic culitis ("microscopic" colitis): a comparative histopathologic study with particular reference to collagenous colitis. Hum Pathol 1989;20:18-28.
3 Giardello FM, Lazenby AJ, Bayless TM, et al. Lymphocytic (microscopic) colitis: clinicopathological study of 18 patients and comparison to collagenous colitis. Dig Dis Sci 1989;34:1730-8.
4 Mullhaupt B, Güller U, Anabitarte M, et al. Lymphocytic colitis: clinical presentation and long term course. Gut 1998;43:629-33.
5 Veress B, Lofberg R, Bergman L. Microscopic colitis syndrome. Gut 1995;36:880-6.
6 Thomson A. Microscopic colitis no longer an appropriate term? Am J Gastroenterol 1998;93:524-6.
7 Chan JL, Tersmette AC, Offerhaus GJA, et al. Cancer risk in patients with lymphocytic and collagenous colitis. Gastroenterology 1998;114:G1462.
8 Riddel RH, Tanaka M, Mazzoleni G. Non-steroidal anti-inflammatory drugs as a possible cause of collagenous colitis: a case control study. Gut 1992;33:683-6.
9 Schmeck-Lindenau HJ, Kurtz W, Heine M. Lymphocytic colitis during ticlodipine therapy [letter]. Disch Med Wochenschr 1998;123:479.
11 Berrebi D, Sautet A, Flejou JF, et al. Ticlodipine induced colitis: a histological study including apoptosis. J Clin Pathol 1998;51:280-3.
12 Beaugeric L, Patey N, Brousse N. Ranitidine, diarrhoea and liymphocytic colitis. Gut 1995;37:708-11.
13 Beaugeric L, Luboinski J, Brousse N, et al. Drug induced lymphocytic colitis. Gut 1994;35:426-8.
14 Giardiello FM, Lazenby AJ, Yardley JH, et al. Increased HLA A1 and diminished HLA A3 in lymphocytic colitis compared with controls and in patients with collagenous colitis. Dig Dis Sci 1992;37:496-9.
15 Bohr J, Tysk C, Yang P, et al. Autoantibodies and immunoglobulins in collagenous colitis. Gut 1996;39:73-6.
16 Järnerot G, Tysk C, Bohr J, et al. Collagenous colitis and faecal stream diversion. Gastroenterology 1995;109:149-55.
17 Bowling TE, Price AB, Al-Adnani M, et al. Interchange between collagenous and lymphocytic colitis in severe disease with auto-immune associations requiring colectomy: a case-report. Gut 1996;38:788-91.