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Clinical Characteristics of Microscopic Colitis in Korea: Prospective Multicenter Study by KASID.

Park YS, Baek DH, Kim WH, Kim JS, Yang SK, Jung SA, Jang BI, Choi CH, Han DS, Kim YH, Chung YW, Kim SW, Kim YS - Gut Liver (2011)

Bottom Line: Nonsteroidal anti-inflammatory drug-associated MCs were observed in 4 cases (18.2%), 3 of which showed improved diarrhea symptoms following discontinuation of the medication.Frequently associated symptoms were abdominal pain and weight loss.Half of the 22 patients with MC improved with conservative care by loperamide or probiotics.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Eulji University College of Medicine, Korea.

ABSTRACT

Background/aims: Microscopic colitis (MC) encompasses collagenous and lymphocytic colitis and is characterized by chronic diarrhea. In cases of MC, colonic mucosae are macroscopically normal, and diagnostic histopathological features are observed only upon microscopic examination. We designed a prospective multicenter study to determine the clinical features, pathological distribution in the colon and prevalence of MC in Korea.

Methods: We prospectively enrolled patients having watery diarrhea no more than 3 times a day between March 2008 and February 2009. We obtained patient histories and performed colonoscopies with random biopsies at each colon segment.

Results: A total of 100 patients with chronic diarrhea were enrolled for a normal colonoscopy and stool exam. MC was observed in 22 patients (22%) (M:F 1.2:1; mean age, 47.5 years). Of those 22 patients, 18 had lymphocytic colitis and 4 had collagenous colitis. The entire colon was affected in only 3 cases (13.6%), the ascending colon in 6 cases (27.2%), the transverse colon in 3 cases (13.6%), and the left colon in 3 cases (13.6%). More than 2 segments were affected in 7 cases (31.8%). Nonsteroidal anti-inflammatory drug-associated MCs were observed in 4 cases (18.2%), 3 of which showed improved diarrhea symptoms following discontinuation of the medication. Frequently associated symptoms were abdominal pain and weight loss. Autoimmune diseases were observed in 4 cases (18.2%). Half of the 22 patients with MC improved with conservative care by loperamide or probiotics.

Conclusions: In a prospective multicenter study of Korean patients with chronic diarrhea, the frequency of MC was found to be approximately 20%, similar to the percentage observed in Western countries. Therefore, the identification of MC is important for the adequate management of Korean patients with chronic diarrhea.

No MeSH data available.


Related in: MedlinePlus

Pathologic finding of microscopic colitis. (A) Lymphocytic colitis (H&E stain, ×400). Note the intraepithelial lymphocytosis and mixed inflammatory infiltrate in the lamina propria, as well as the surface epithelial damage. In distinction from ulcerative colitis or Crohn's colitis, the crypt architecture is normal. (B) Collagenous colitis (H&E stain, ×200). (C) Collagenous colitis (Masson's trichrome stain, ×400). In addition to the inflammatory infiltrate, note the thickened subepithelial collagen band.
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Figure 1: Pathologic finding of microscopic colitis. (A) Lymphocytic colitis (H&E stain, ×400). Note the intraepithelial lymphocytosis and mixed inflammatory infiltrate in the lamina propria, as well as the surface epithelial damage. In distinction from ulcerative colitis or Crohn's colitis, the crypt architecture is normal. (B) Collagenous colitis (H&E stain, ×200). (C) Collagenous colitis (Masson's trichrome stain, ×400). In addition to the inflammatory infiltrate, note the thickened subepithelial collagen band.

Mentions: Two mucosal biopsies were taken from every segment of the colon (cecum, ascending colon, transverse colon, descending colon, and sigmoid colon) and from the rectum. The histological features of microscopic colitis are chronic inflammatory cells infiltrating the lamina propria of mucosa, increase of intraepithelial lymphocyte (IEL) and epithelial damage, such as flattening and detachment. The number of IEL is more than 20 in 100 epithelial cells in lymphocytic colitis (LC) (Fig. 1A). The thickness of subepithelial collagen layer is more than 10 µm in collagenous colitis (CC) (Fig. 1B and C). Also we divided into two subgrouped, if the case shows the number of lymphocyte is 10 to 20 in 100 epithelial cells diagnosed as suspicious LC and the thickness of the collagen layer is 5 to 10 µm diagnosed as suspicious CC.


Clinical Characteristics of Microscopic Colitis in Korea: Prospective Multicenter Study by KASID.

Park YS, Baek DH, Kim WH, Kim JS, Yang SK, Jung SA, Jang BI, Choi CH, Han DS, Kim YH, Chung YW, Kim SW, Kim YS - Gut Liver (2011)

Pathologic finding of microscopic colitis. (A) Lymphocytic colitis (H&E stain, ×400). Note the intraepithelial lymphocytosis and mixed inflammatory infiltrate in the lamina propria, as well as the surface epithelial damage. In distinction from ulcerative colitis or Crohn's colitis, the crypt architecture is normal. (B) Collagenous colitis (H&E stain, ×200). (C) Collagenous colitis (Masson's trichrome stain, ×400). In addition to the inflammatory infiltrate, note the thickened subepithelial collagen band.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3140663&req=5

Figure 1: Pathologic finding of microscopic colitis. (A) Lymphocytic colitis (H&E stain, ×400). Note the intraepithelial lymphocytosis and mixed inflammatory infiltrate in the lamina propria, as well as the surface epithelial damage. In distinction from ulcerative colitis or Crohn's colitis, the crypt architecture is normal. (B) Collagenous colitis (H&E stain, ×200). (C) Collagenous colitis (Masson's trichrome stain, ×400). In addition to the inflammatory infiltrate, note the thickened subepithelial collagen band.
Mentions: Two mucosal biopsies were taken from every segment of the colon (cecum, ascending colon, transverse colon, descending colon, and sigmoid colon) and from the rectum. The histological features of microscopic colitis are chronic inflammatory cells infiltrating the lamina propria of mucosa, increase of intraepithelial lymphocyte (IEL) and epithelial damage, such as flattening and detachment. The number of IEL is more than 20 in 100 epithelial cells in lymphocytic colitis (LC) (Fig. 1A). The thickness of subepithelial collagen layer is more than 10 µm in collagenous colitis (CC) (Fig. 1B and C). Also we divided into two subgrouped, if the case shows the number of lymphocyte is 10 to 20 in 100 epithelial cells diagnosed as suspicious LC and the thickness of the collagen layer is 5 to 10 µm diagnosed as suspicious CC.

Bottom Line: Nonsteroidal anti-inflammatory drug-associated MCs were observed in 4 cases (18.2%), 3 of which showed improved diarrhea symptoms following discontinuation of the medication.Frequently associated symptoms were abdominal pain and weight loss.Half of the 22 patients with MC improved with conservative care by loperamide or probiotics.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Eulji University College of Medicine, Korea.

ABSTRACT

Background/aims: Microscopic colitis (MC) encompasses collagenous and lymphocytic colitis and is characterized by chronic diarrhea. In cases of MC, colonic mucosae are macroscopically normal, and diagnostic histopathological features are observed only upon microscopic examination. We designed a prospective multicenter study to determine the clinical features, pathological distribution in the colon and prevalence of MC in Korea.

Methods: We prospectively enrolled patients having watery diarrhea no more than 3 times a day between March 2008 and February 2009. We obtained patient histories and performed colonoscopies with random biopsies at each colon segment.

Results: A total of 100 patients with chronic diarrhea were enrolled for a normal colonoscopy and stool exam. MC was observed in 22 patients (22%) (M:F 1.2:1; mean age, 47.5 years). Of those 22 patients, 18 had lymphocytic colitis and 4 had collagenous colitis. The entire colon was affected in only 3 cases (13.6%), the ascending colon in 6 cases (27.2%), the transverse colon in 3 cases (13.6%), and the left colon in 3 cases (13.6%). More than 2 segments were affected in 7 cases (31.8%). Nonsteroidal anti-inflammatory drug-associated MCs were observed in 4 cases (18.2%), 3 of which showed improved diarrhea symptoms following discontinuation of the medication. Frequently associated symptoms were abdominal pain and weight loss. Autoimmune diseases were observed in 4 cases (18.2%). Half of the 22 patients with MC improved with conservative care by loperamide or probiotics.

Conclusions: In a prospective multicenter study of Korean patients with chronic diarrhea, the frequency of MC was found to be approximately 20%, similar to the percentage observed in Western countries. Therefore, the identification of MC is important for the adequate management of Korean patients with chronic diarrhea.

No MeSH data available.


Related in: MedlinePlus