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Kotze LMDS, Kotze PG, Kotze LR, Nisihara R. MICROSCOPIC COLITIS: CONSIDERATIONS FOR GASTROENTEROLOGISTS, ENDOSCOPISTS, AND PATHOLOGISTS. Arq Gastroenterol 2023; 60:188-193. [PMID: 37556744 DOI: 10.1590/s0004-2803.20230222-143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/27/2023] [Indexed: 08/11/2023]
Abstract
•Diagnosis of microscopic colitis necessitates effective communication among gastroenterologists, endoscopists, and pathologists. •The gastroenterologist should refer every patient with chronic watery diarrhea to perform a colonoscopy in spite of the benign course of the disease and the absence of alarm symptoms. •The endoscopist should take 2 or 3 biopsy samples of the colonic mucosa from the right and left colon, put in separate recipients, despite that the mucosa looked macroscopically normal. •The pathologist should be encouraged to use objective histological criteria to make the diagnosis. Microscopic colitis is a chronic inflammatory bowel disease characterized by non-bloody diarrhea that can range from mild to severe. It is difficult to attribute up to 10-20% of chronic diarrhea to microscopic colitis. The three determinants factors of the diagnosis are characteristic clinical symptoms, normal endoscopic picture of the colon, and pathognomonic histological picture. This manuscript aimed to update considerations and recommendations for professionals involved (gastroenterologist, endoscopists and pathologist) in the diagnosis of MC. In addition, a short recommendation about treatment.
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Affiliation(s)
| | - Paulo Gustavo Kotze
- Pontifícia Universidade Católica do Paraná, Programa de Pós-Graduação em Ciências da Saúde, Ambulatório de Doenças Inflamatórias Intestinais, Curitiba, PR, Brasil
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Koulaouzidis A, Toth E. Magnifying advanced endoscopy in collagenous colitis: now you see? Endosc Int Open 2017; 5:E1074-E1075. [PMID: 29250582 PMCID: PMC5659866 DOI: 10.1055/s-0043-118412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Anastasios Koulaouzidis
- Endoscopy Unit, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom,Corresponding author Anastasios Koulaouzidis, MD Endoscopy UnitThe Royal Infirmary of Edinburgh51 Little France CrescentEdinburgh EH164SAUnited Kingdom+44-131-2421619
| | - Ervin Toth
- Endoscopy Unit, Skåne University Hospital, Lund University, Malmö, Sweden
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Kobayashi M, Hoshi T, Morita SI, Kanefuji T, Suda T, Hasegawa G, Terai S. Magnifying image-enhanced endoscopy for collagenous colitis. Endosc Int Open 2017; 5:E1069-E1073. [PMID: 29250581 PMCID: PMC5659867 DOI: 10.1055/s-0043-118004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 06/14/2017] [Indexed: 02/07/2023] Open
Abstract
Background and study aims We report a case series of 5 patients with collagenous colitis (CC) presenting with chronic watery diarrhea, who were subjected to magnifying, chromoendoscopy and narrow band imaging (NBI). Magnifying chromoendoscopy revealed whitish-clouded, honeycomb-like appearance at orifices of the crypts. NBI with high magnification revealed irregular caliber variation of the subepithelial capillary network. Presence of these features corresponded with histological characteristics of CC indicated by thickening of the subepithelial collagen layer. We concluded that magnifying image-enhanced endoscopy is a reliable tool to diagnose CC.
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Affiliation(s)
- Masaaki Kobayashi
- Department of Gastroenterology and Hepatology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
- Corresponding author Masaaki Kobayashi Department of Gastroenterology and HepatologyUonuma Institute of Community MedicineNiigata University Medical and Dental Hospital4132 Urasa, Minami-UonumaNiigata 949-7302, Japan+81-25-777-2811
| | - Takahiro Hoshi
- Department of Gastroenterology and Hepatology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Shin-ich Morita
- Department of Gastroenterology and Hepatology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Tsutomu Kanefuji
- Department of Gastroenterology and Hepatology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Takeshi Suda
- Department of Gastroenterology and Hepatology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Go Hasegawa
- Department of Pathology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Shuji Terai
- Division of Gastroenterology and Hepatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Grassia R, Capone P, Villanacci V, Tanzi GP, Buffoli F. Endoscopic features of microscopic colitis: The "grid-like" pattern detected with HD+ colonoscopy plus i-scan. Dig Liver Dis 2017; 49:318-319. [PMID: 28174001 DOI: 10.1016/j.dld.2017.01.143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 01/06/2017] [Accepted: 01/09/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Roberto Grassia
- Digestive Endoscopy and Gastroenterology Unit, "ASST di Cremona", Cremona, Italy.
| | - Pietro Capone
- Digestive Endoscopy and Gastroenterology Unit, "ASST di Cremona", Cremona, Italy
| | | | | | - Federico Buffoli
- Digestive Endoscopy and Gastroenterology Unit, "ASST di Cremona", Cremona, Italy
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Koulaouzidis A, Yung DE, Nemeth A, Sjöberg K, Giannakou A, Qureshi R, Bartzis L, McNeill M, Johansson GW, Lucendo AJ, Fineron P, Trimble KC, Saeed A, Plevris JN, Toth E. Macroscopic findings in collagenous colitis: a multi-center, retrospective, observational cohort study. Ann Gastroenterol 2017; 30:309-314. [PMID: 28469361 PMCID: PMC5411381 DOI: 10.20524/aog.2017.0131] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 12/28/2016] [Indexed: 12/16/2022] Open
Abstract
Background Collagenous colitis (CC) is by definition a histological diagnosis. However, colonoscopy often reveals characteristic endoscopic findings. The aim of this study was to evaluate the frequency and type of endoscopic findings in patients diagnosed with CC in 4 participating centers. Methods This was a retrospective study; the databases of 2 university hospitals in Edinburgh (Scotland) and Malmö (Sweden), and 2 district general hospitals in Tomelloso (Spain) and Gateshead (England) were interrogated for patients diagnosed with CC between May 2008 and August 2013. Endoscopy reports and images were retrieved and reviewed; data on lesions, sedation, bowel preparation and endoscopist experience were abstracted. Categorical data are reported as mean±SD. Fischer’s exact, chi-square and t (unpaired) tests were used to compare datasets. A two-tailed P-value of <0.05 was considered statistically significant. Results 607 patients (149 male, mean age 66.9±12.25 years) were diagnosed with CC. A total of 108/607 (17.8%) patients had one or more suggestive endoscopy findings: i.e., mucosal erythema/edema, 91/607 (15%); linear colonic mucosal defects, 12/607 (2%); or mucosal scarring, 5/607 (0.82%). For colonic mucosa erythema, there was no difference in the odds of finding erythema with the use of different bowel preparation methods (P=0.997). For colonic mucosal defects there was some evidence (P=0.005) that patients colonoscoped by experienced endoscopists had 87% less odds of developing such defects. Moreover, there was evidence that analgesia reduced the odds of developing mucosal defects by 84%. Conclusion A significant minority of patients with CC have endoscopic findings in colonoscopy. The description of such findings appears to be related to the endoscopist’s experience.
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Affiliation(s)
- Anastasios Koulaouzidis
- Endoscopy Unit, The Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK (Anastasios Koulaouzidis, Diana E. Yung, Leonidas Bartzis, Ken C. Trimble, John N. Plevris)
| | - Diana E Yung
- Endoscopy Unit, The Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK (Anastasios Koulaouzidis, Diana E. Yung, Leonidas Bartzis, Ken C. Trimble, John N. Plevris)
| | - Artur Nemeth
- Endoscopy Unit, Skåne University Hospital, Malmö, Sweden (Artur Nemeth, Gabriele Wurm Johansson, Ervin Toth)
| | - Klas Sjöberg
- Department of Gastroenterology and Nutrition, Skåne University Hospital, Lund University, Malmö, Sweden (Klas Sjöberg)
| | - Andry Giannakou
- Faculty of Economics & Management, Open University of Cyprus, Nicosia, Cyprus (Andry Giannakou)
| | - Raheel Qureshi
- Gastroenterology Department, Queen Elizabeth Hospital, Gateshead, England, UK (Raheel Qureshi, Athar Saeed)
| | - Leonidas Bartzis
- Endoscopy Unit, The Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK (Anastasios Koulaouzidis, Diana E. Yung, Leonidas Bartzis, Ken C. Trimble, John N. Plevris)
| | - Morna McNeill
- Department of Pathology, Western General Hospital, Edinburgh, Scotland, UK (Morna McNeill, Paul Fineron)
| | - Gabriele Wurm Johansson
- Endoscopy Unit, Skåne University Hospital, Malmö, Sweden (Artur Nemeth, Gabriele Wurm Johansson, Ervin Toth)
| | - Alfredo J Lucendo
- Gastroenterology Department, Hospital General de Tomelloso, Spain (Alfredo J. Lucendo)
| | - Paul Fineron
- Department of Pathology, Western General Hospital, Edinburgh, Scotland, UK (Morna McNeill, Paul Fineron)
| | - Ken C Trimble
- Endoscopy Unit, The Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK (Anastasios Koulaouzidis, Diana E. Yung, Leonidas Bartzis, Ken C. Trimble, John N. Plevris)
| | - Athar Saeed
- Gastroenterology Department, Queen Elizabeth Hospital, Gateshead, England, UK (Raheel Qureshi, Athar Saeed)
| | - John N Plevris
- Endoscopy Unit, The Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK (Anastasios Koulaouzidis, Diana E. Yung, Leonidas Bartzis, Ken C. Trimble, John N. Plevris)
| | - Ervin Toth
- Endoscopy Unit, Skåne University Hospital, Malmö, Sweden (Artur Nemeth, Gabriele Wurm Johansson, Ervin Toth)
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Mellander MR, Ekbom A, Hultcrantz R, Löfberg R, Öst Å, Björk J. Microscopic colitis: a descriptive clinical cohort study of 795 patients with collagenous and lymphocytic colitis. Scand J Gastroenterol 2016; 51:556-62. [PMID: 26679722 DOI: 10.3109/00365521.2015.1124283] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Microscopic colitis is a common cause of chronic diarrhoea in the Scandinavian countries. This report comprises demographic data, clinical and endoscopic features, and occurrence of coeliac and inflammatory bowel disease (IBD) in a large urban cohort of patients with lymphocytic colitis (LC) and collagenous colitis (CC). MATERIALS AND METHODS A total of 795 patients with microscopic colitis from two hospitals in Stockholm were included. Medical records were reviewed and clinical data, including endoscopic and histological findings, were compiled. RESULTS Forty-three percent had CC (female:male ratio 3.7:1) and 57% had LC (female:male ratio 2.7:1). The mean age at diagnosis of CC was 63 years and of LC was 59 years (p = 0.005). Clinical features were similar in both entities, but the intensity of symptoms differed. Watery diarrhoea was reported in 55% in CC patients versus in 43% in LC patients (p = 0.0014), and nocturnal diarrhoea in 28% versus 18% (p = 0.002). Subtle endoscopic mucosal findings were reported in 37% of the CC patients and in 25% of the LC patients (p = 0.0011). Colorectal adenomatous polyps were found in 5.3% of all patients. Coeliac disease occurred in 6% and IBD occurred in 2.1% of all patients. CONCLUSIONS Clinical features of LC and CC are similar but not identical. CC seems to be a more severe type of bowel inflammation and LC tends to occur earlier in life. Both forms might indeed feature endoscopic findings despite the designation 'microscopic'. Our study confirms the strong association with coeliac disease.
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Affiliation(s)
- Marie-Rose Mellander
- a Department of Gastroenterology and Hepatology , Karolinska Institute, Karolinska University Hospital , Solna , Sweden
| | - Anders Ekbom
- b Epidemiology Unit, Department of Medicine , Karolinska Institute, Karolinska University Hospital , Solna , Sweden
| | - Rolf Hultcrantz
- a Department of Gastroenterology and Hepatology , Karolinska Institute, Karolinska University Hospital , Solna , Sweden
| | - Robert Löfberg
- c IBD Unit, Karolinska Institute, Sophiahemmet , Stockholm , Sweden
| | - Åke Öst
- d Department of Pathology and Cytology , Medilab , Täby , Sweden
| | - Jan Björk
- a Department of Gastroenterology and Hepatology , Karolinska Institute, Karolinska University Hospital , Solna , Sweden
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Rubio CA, Ichiya T, Schmidt PT. Lymphocytic oesophagitis, eosinophilic oesophagitis and compound lymphocytic-eosinophilic oesophagitis I: histological and immunohistochemical findings. J Clin Pathol 2016; 70:208-216. [PMID: 27471274 DOI: 10.1136/jclinpath-2016-203782] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/21/2016] [Accepted: 07/02/2016] [Indexed: 01/18/2023]
Abstract
AIMS To report four histological-immunohistochemical oesophagitis phenotypes. METHODS Oesophageal biopsies from 311 patients were stained with H&E and with CD3, a T cell marker. Additional immunohistochemical stains (n=413) were performed in 77 cases. RESULTS Four histological-immunohistochemical oesophagitis phenotypes were recorded: lymphocytic oesophagitis (LyE, ≥40 CD3+ lymphocytes/HPF in CD3 immunostain), eosinophilic oesophagitis (EoE, ≥15 eosinophils/HPF in H&E stain), lymphocytic infiltration (≤39 CD3+/HPF) and compound lymphocytic oesophagitis-eosinophilic oesophagitis (Co LyE-EoE). At index biopsy, 28.3% (n=88) had LyE, 21.2% (n=66) EoE, 10.6% (n=33) Co LyE-EoE and 39.9% (n=124) lymphocytic infiltration. A persistent oesophagitis phenotype was found in 42.5% (37/87) in the first follow-up biopsy, in 34.4% (21/61) in the second follow-up biopsy and in 48.1% (26/54) in the third follow-up biopsy. Using βF1 immunostain, two different surface T cell receptors were detected in LyE and Co Lye-EoE: one having ≥40 βF1+/HPF (βF1+ high) and the other having <39 βF1+/HPF (βF1+ low). CONCLUSIONS Based on the literature regarding the significance of intraepithelial lymphocytes (IELs) in the initiation of EoE, we submit that the IEL phenotypes in LyE might differ from those found in EoE as they were unable to elicit the same eosinophilic response. Recent studies disclosed that group 2 innate lymphocytes (ILC2s), enriched in EoE, remain undetected in CD3 immunostain as they lack surface markers for T, B, natural killer (NK) or NK T cells. If ILC2s also participate in the lymphocytic infiltration of EoE, then the frequency of cases with Co LyE-EoE here reported might have been much higher. The four oesophagitis phenotypes described are easy to recognise, provided that the dual staining procedure (H&E-CD3) is implemented.
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Affiliation(s)
- C A Rubio
- Department of Pathology, Karolinska Institute and University Hospital, Stockholm, Sweden
| | - T Ichiya
- Department of Medicine, Center for Digestive Diseases, Karolinska Institute and University Hospital, Stockholm, Sweden
| | - P T Schmidt
- Department of Medicine, Center for Digestive Diseases, Karolinska Institute and University Hospital, Stockholm, Sweden
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Zabana Y, Ferrer C, Aceituno M, Salas A, Fernández-Bañares F. Advances for improved diagnosis of microscopic colitis in patients with chronic diarrhoea. Gastroenterol Hepatol 2016; 40:107-116. [PMID: 26996466 DOI: 10.1016/j.gastrohep.2016.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 12/29/2015] [Accepted: 01/18/2016] [Indexed: 02/07/2023]
Abstract
Microscopic colitis is a generic term that includes 2 main forms, collagenous colitis and lymphocytic colitis, and describes a form of inflammatory bowel disease with a chronic and relapsing course. The incidence of microscopic colitis is between 2 and 8 times higher in women than in men, although age, more than sex, increases the risk of collagenous colitis (odds ratio [OR] 8.3 for age ≥65 vs. <65 and OR 2.8 for women). The main symptom is chronic non-bloody watery diarrhoea. Other common symptoms include abdominal pain (50%-70%), with the result that many patients with microscopic colitis meet criteria for irritable bowel syndrome. Colonoscopy with multiple colonic biopsies is currently recommended, as histological changes are the main characteristic feature. The colonic mucosa is macroscopically normal, although certain minimal endoscopic abnormalities have been described.
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Affiliation(s)
- Yamile Zabana
- Servicios de Digestivo, Hospital Universitari Mútua Terrassa, CIBERehd, Terrassa, Barcelona, España
| | - Carme Ferrer
- Anatomía Patológica, Hospital Universitari Mútua Terrassa, CIBERehd, Terrassa, Barcelona, España
| | - Montserrat Aceituno
- Servicios de Digestivo, Hospital Universitari Mútua Terrassa, CIBERehd, Terrassa, Barcelona, España
| | - Antonio Salas
- Anatomía Patológica, Hospital Universitari Mútua Terrassa, CIBERehd, Terrassa, Barcelona, España
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Fernández-Bañares F, Casanova MJ, Arguedas Y, Beltrán B, Busquets D, Fernández JM, Fernández-Salazar L, García-Planella E, Guagnozzi D, Lucendo AJ, Manceñido N, Marín-Jiménez I, Montoro M, Piqueras M, Robles V, Ruiz-Cerulla A, Gisbert JP. Current concepts on microscopic colitis: evidence-based statements and recommendations of the Spanish Microscopic Colitis Group. Aliment Pharmacol Ther 2016; 43:400-26. [PMID: 26597122 DOI: 10.1111/apt.13477] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 10/01/2015] [Accepted: 10/23/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND Microscopic colitis (MC) is an underdiagnosed inflammatory bowel disease. AIM To develop an evidence-based clinical practice guide on MC current concepts. METHODS Literature search was done on the Cochrane Library, EMBASE and MEDLINE electronic databases, which were consulted covering the period up until March 2015. Work groups were selected for each of the reviewed topics, with the purpose of drafting the initial statements and recommendations. They subsequently underwent a voting process based on the Delphi method. Each statement/recommendation was accompanied by the result of the vote the level of evidence, and discussion of the corresponding evidence. The grade of recommendation (GR) using the GRADE approach was established for diagnosis and treatment recommendations. RESULTS Some key statements and recommendations are: advancing age increases the risk of developing MC, mainly in females. The symptoms of MC and IBS-D may be similar. If MC is suspected, colonoscopy taking biopsies is mandatory. Treatment with oral budesonide is recommended to induce clinical remission in patients with MC. Oral mesalazine is not recommended in patients with collagenous colitis for the induction of clinical remission. The use of anti-TNF-alpha drugs (infliximab, adalimumab) is recommended for the induction of remission in severe cases of MC that fail to respond to corticosteroids or immunomodulators, as an alternative to colectomy. CONCLUSIONS This is the first consensus paper on MC based on GRADE methodology. This initiative may help physicians involved in care of these patients in taking decisions based on evidence.
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Affiliation(s)
- F Fernández-Bañares
- Hospital Universitari Mutua Terrassa, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - M J Casanova
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | | | - B Beltrán
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
- Hospital La Fe, Valencia, Spain
| | - D Busquets
- Hospital Doctor Josep Trueta, Girona, Spain
| | - J M Fernández
- Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | | | | | | | - A J Lucendo
- Hospital General de Tomelloso, Ciudad Real, Spain
| | - N Manceñido
- Hospital Infanta Sofía, San Sebastián de los Reyes, Spain
| | - I Marín-Jiménez
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | - V Robles
- Hospital Vall d'Hebron, Barcelona, Spain
| | | | - J P Gisbert
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
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Affiliation(s)
- Michael D Share
- Department of Internal Medicine, University of California at Los Angeles Medical Center, Los Angeles, California 90095, USA
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Abstract
The pathogenesis of inflammatory bowel disease (IBD) is multifactorial and results from an interaction between genetic, immunologic, microbial, and environmental factors. Certain drugs could act as a trigger for the disease and have been implicated in the development of new onset IBD in a number a studies. These relationships are based on case reports and cohort studies, as proving this in the context of randomized controlled trials would be difficult. Drugs that have been linked to causing or worsening IBD include isotretinoin, antibiotics, nonsteroidal antiinflammatory drugs, oral contraceptives, mycophenolate mofetil, etanercept, ipilimumab, and rituximab. Bowel preparation for colonoscopy has also been associated with aphthoid lesions that may be confused with IBD. However, given the source of these reports we have to be cautious in the interpretation of the data before concluding that these drugs trigger IBD and what is being observed is not related to other confounding factors. Different pathogenic mechanisms have been suggested for the different drugs listed above. In order to clarify the confusion a comprehensive literature review was performed with the goal of advancing the knowledge on this subject.
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Affiliation(s)
- Marie-France Dubeau
- Inflammatory Bowel Disease Clinic and the Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada
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Abstract
BACKGROUND The use of dyes during cystoscopy to visualize the ureters adequately is prevalent in gynecologic surgery. Observing ureteral patency after procedures such as a hysterectomy or pelvic reconstruction is important for identifying injury to the upper urinary tract. Indigo carmine is commonly used. Knowing the possible adverse effects and being aware of unusual presentations with the use of indigo carmine are important in managing and counseling patients. CASE We present a case in which a patient developed indigo carmine extravasation to her upper limb after pelvic reconstructive surgery. The blue discoloration disappeared after 1 day. CONCLUSION Indigo carmine extravasation to other parts of the body can occur without long-term complications. It takes 24-48 hours for the dye to clear subcutaneously.
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Smirnidis A, Alexandridis E, Koulaouzidis A. Colonic lacerations, mucosal scars and image enhancement: an on-the-spot diagnosis. Saudi J Gastroenterol 2013; 19:54-5. [PMID: 23319039 PMCID: PMC3603491 DOI: 10.4103/1319-3767.105929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Alexandros Smirnidis
- Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Anastasios Koulaouzidis
- Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK,Address for correspondence: Dr. Anastasios Koulaouzidis, Centre for Liver and Digestive Disorders, 51 Little France Crescent, Edinburgh, Scotland, EH16 4SA, UK. E-mail:
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Abstract
Microscopic colitis may be defined as a clinical syndrome, of unknown etiology, consisting of chronic watery diarrhea, with no alterations in the large bowel at the endoscopic and radiologic evaluation. Therefore, a definitive diagnosis is only possible by histological analysis. The epidemiological impact of this disease has become increasingly clear in the last years, with most data coming from Western countries. Microscopic colitis includes two histological subtypes [collagenous colitis (CC) and lymphocytic colitis (LC)] with no differences in clinical presentation and management. Collagenous colitis is characterized by a thickening of the subepithelial collagen layer that is absent in LC. The main feature of LC is an increase of the density of intra-epithelial lymphocytes in the surface epithelium. A number of pathogenetic theories have been proposed over the years, involving the role of luminal agents, autoimmunity, eosinophils, genetics (human leukocyte antigen), biliary acids, infections, alterations of pericryptal fibroblasts, and drug intake; drugs like ticlopidine, carbamazepine or ranitidine are especially associated with the development of LC, while CC is more frequently linked to cimetidine, non-steroidal antiinflammatory drugs and lansoprazole. Microscopic colitis typically presents as chronic or intermittent watery diarrhea, that may be accompanied by symptoms such as abdominal pain, weight loss and incontinence. Recent evidence has added new pharmacological options for the treatment of microscopic colitis: the role of steroidal therapy, especially oral budesonide, has gained relevance, as well as immunosuppressive agents such as azathioprine and 6-mercaptopurine. The use of anti-tumor necrosis factor-α agents, infliximab and adalimumab, constitutes a new, interesting tool for the treatment of microscopic colitis, but larger, adequately designed studies are needed to confirm existing data.
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