Collagenous colitis

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Collagenous colitis Definition

Collagenous colitis is an inflammatory disease of the colon, which is related with watery and chronic diarrhea, but without blood [1]. It is one form of microscopic colitis, the other being lymphocytic colitis.

Collagenous colitis Incidence

The incidence is high in industrialized countries like United States, Canada, Europe, New Zealand and Australia. Estimates indicate that the incidence has increased from one to approximately 19 in every 100,000 individuals. The prevalence increases with age and peaks in people in their 70s [2].

Collagenous colitis Symptoms

These involve:

  • Intermittent bouts of diarrhea
  • Painful abdominal cramps
  • Multiple episodes of loose, watery bowel movements every day
  • Dehydration and fatigue (acute cases)

Such episodes may arise abruptly, without any apparent reason [3].

Collagenous colitis Etiology

The exact causes are unclear [4]. As per some unproven theories, the underlying factors might be:

  • Some auto immune disorder
  • Damage from food poisoning
  • Association with NSAIDs or non-steroidal anti-inflammatory medications (Ibuprofen etc.)

Around half of all sufferers can identify the particular time of occurrence of the first bout.

Associated disorders

These involve:

  • Coeliac disease
  • Lymphoma
  • Autoimmune disorders like thyroid disease and rheumatoid arthritis (as seen in 20-60% sufferers)

Collagenous colitis Risk Factors

Adults over 40 years of age are usually the most risk-prone. People suffering from an autoimmune disorder are also regarded as susceptible by doctors [5].

Collagenous colitis Diagnosis

Diagnosis involves:

  • Physical examination
  • Analysis of medical history
  • Laboratory analysis of stool and blood samples (often yielding normal findings)

A series of diagnostic tests are often ordered to ascertain the exact cause/causes. These involve:

  • Scope test (sigmoidoscopy, colonoscopy etc.)
  • Microscopic examination of colonic biopsies [6]

Collagenous colitis Differential Diagnosis

Biopsies of the colon should be examined under microscope to avoid misdiagnosis as irritable bowel syndrome (IBS) or lymphocytic colitis.

Collagenous colitis Treatment

Despite multiple management and curative options being present, no single treatment option is regarded as effective for Collagenous colitis. Treatment only aims at reducing inflammation and diarrhea symptoms. Treatment options include:

Medications

These include:

  • Anti-inflammatory agents like Azulfidine (sulfasalizine) or Asacol (mesalamine) [7]
  • Steroid drugs like Prednisone or Entocort
  • High dose Pepto-bismol
  • Drugs like Imodium (loperamide) and Lomotil (diphenoxylate), to treat diarrhea
  • Cholestryramine, to limit diarrhea
  • Antibiotic therapy (Flagyl, penicillin and erythromycin)

Probiotics (Healthy bacteria)

Acidophyllus (found in yogurt), Florastor and Culturelle help restore the balance of beneficial bacteria inside the colon.

Diet

Although no specific diet is recommended, patients should avoid lactose or caffeine to avoid fluid secretion in the colon. Low-fat diets should be followed in the event of inability to digest fats.

Surgery

Radical surgery (for colon removal and creating a diverting ileostomy) is a possible cure, but is mainly reserved for acute cases and is seldom recommended.

Home Remedies

These include:

  • Drinking lots of fluids (rich in sodium and potassium), watered-down fruit juice or broth
  • Consuming soft foods (like rice, bananas or applesauce)
  • Eating multiple small meals than a single large meal

Collagenous colitis Complications

The possible complications include:

  • Weight loss
  • Severe dehydration
  • Vitamin deficiency
  • Loss of bone density and hypertension (due to long-term steroidal treatment) [8]

Can Collagenous colitis kill you?

It is not life-threatening. However, there are cases that need intensive resuscitation – particularly those associated with vitamin deficiency, weight loss and acute dehydration.

Collagenous colitis Prognosis

Symptoms usually recur when treatment is slowed down. Most patients require continual therapy for management of the symptoms. The long term outcome varies, with some sufferers showing quick response and others taking time. There is also a waxing and waning period of symptoms. Continued treatment usually reduces problems.

Collagenous colitis Prevention

Worsening of the symptoms can be prevented by measures like:

  • Non-intake of irritating foods (fried, or rich in fat or spicy foods are to be avoided)
  • Avoiding beverages like alcohol, caffeine or tea (high in sugar) [9]

As the exact cause is unknown, the condition itself cannot be prevented.

Although often difficult to cure completely, Collagenous colitis can be managed with proper medical assistance as much as to make a better quality of life possible for sufferers.

References

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