RESUMO
The clinical case of a patient in the fifth decade of life with a diagnosis of lymphocytic colitis is presented, who comes for chronic diarrhea, which receives treatment with Budesonide with partial response.
Assuntos
Colite Linfocítica , Colite , Humanos , Colite Linfocítica/diagnóstico , Colite Linfocítica/tratamento farmacológico , Budesonida/uso terapêutico , Diarreia/etiologia , Diarreia/tratamento farmacológicoRESUMO
Microscopic colitis (MC) is a clinical condition characterized by chronic watery diarrhea, normal colonic mucosa and characteristic histological findings. It is composed of two main entities: collagenous colitis (CC) and lymphocytic colitis (LC). Its incidence has been increasing, currently accounting for between 8 to 16% of studies for chronic diarrhea. It is more frequent in elderly women and is strongly associated with other autoimmune disorders. Its pathogenesis is not very well understood, but it supposes the immune activation secondary to the exposure of the colonic mucosa to different luminal antigens, mainly drugs. Management includes suspension of the potential causative agent and the use of anti-diarrheal medications. Oral budesonide has proven to be effective in induction and maintenance of remission, but with a high rate of recurrence upon discontinuation. Immune-modulators drugs such as azatioprine and metrotrexate have been tested in patients dependent to corticoids with variable results. Antibodies against tumor necrosis factors (TNF) are under studies, with promising results.
La colitis microscópica (CM) es una condición clínica caracterizada por diarrea crónica acuosa con mucosa colónica normal y hallazgos histológicos característicos. Está compuesta por dos entidades principales: la colitis colágena (CC) y la colitis linfocítica (CL). Su incidencia ha ido en aumento, siendo en la actualidad la responsable del 8 a 16% de los casos por diarrea crónica. Es más frecuente en mujeres de edad avanzada con una fuerte asociación a otras enfermedades autoinmunes. Su etiopatogenia no es del todo conocida, pero se cree juega un rol la activación inmune secundaria a la exposición de la mucosa colónica a diferentes antígenos luminales, principalmente fármacos. Dentro del manejo se incluye la suspensión del potencial agente causal y el uso de fármacos antidiarreicos. La budesonida oral ha demostrado alta efectividad en la inducción y mantención de la remisión, pero con una alta tasa de recurrencia al suspenderla. Fármacos inmunomoduladores como azatioprina y metrotrexato se han probado en pacientes corticodependendientes con resultados variables. El uso de anticuerpos monoclonales anti factor de necrosis tumoral (TNF) se encuentra en estudio, con resultados prometedores.
Assuntos
Humanos , Colite Microscópica/diagnóstico , Colite Microscópica/tratamento farmacológico , Corticosteroides , Mesalamina/uso terapêutico , Budesonida/uso terapêutico , Colite Colagenosa/diagnóstico , Colite Colagenosa/tratamento farmacológico , Colite Linfocítica/diagnóstico , Colite Linfocítica/tratamento farmacológico , Diarreia/etiologia , Anti-Inflamatórios/uso terapêutico , Anticorpos Monoclonais , Antidiarreicos/uso terapêuticoRESUMO
Introducción: Algunos autores han demostrado incremento de células neuroendócrinas en colitis microscópica y colitis ulcerativa. Objetivo: El objetivo del presente estudio fue evaluar la presencia de células neuroendócrinas en colitis linfocítica, colitis colagenosa y colitis ulcerativa en comparación a controles. Materiales y métodos: Se usó inmunohistoquímica para identificar a las células neuroendócrinas a través del marcador cromogranina A. El estudio incluyó 10 casos de cada diagnóstico de colitis linfocítica, colitis colagenosa y colitis ulcerativa. Resultados: Se encontró diferencia estadísticamente significativa en el conteo de células neuroendocrinas en colitis linfocítica (p=0,019104) y colitis ulcerativa en comparación con los controles (p=0,0077). En colitis colagenosa, se encontró un incremento de células neuroendocrinas pero no pudimos demostrar diferencias estadísticamente significativa. Conclusión: Se demostró hiperplasia de células neuroendocrinas en colitis linfocítica y colitis ulcerativa, lo que confirma lo reportado por los pocos estudios anteriores realizados sobre el tema.
Introduction: Some authors have found increase of neuroendocrine cells in microscopic colitis and ulcerative colitis. Objective: The aim of this study is to evaluate the presence of neuroendocrine cells in ulcerative colitis and lymphocytic colitis and collagenous colitis. Materials and methods: Immunohistochemistry was performed to identify neuroendocrine cells through marker chromogranin A (CgA). The study included 10 cases of each diagnosis of Lymphocytic colitis, collagenous colitis and ulcerative colitis. Results: There was statistically significant difference in the count of neuroendocrine cells, between lymphocytic colitis and control (p=0.019104), and between ulcerative colitis and controls (p=0.0077). In collagenous colitis there was an increase in neuroendocrine cells but we failed to find statistical differences. Conclusion: We could observe neuroendocrine cell hyperplasia in lymphocytic colitis and ulcerative colitis compared with controls, which confirm previous studies.
Assuntos
Humanos , Colite Ulcerativa/patologia , Colite Colagenosa/patologia , Colite Linfocítica/patologia , Células Neuroendócrinas/patologia , HiperplasiaRESUMO
INTRODUCTION: Some authors have found increase of neuroendocrine cells in microscopic colitis and ulcerative colitis. OBJECTIVE: The aim of this study is to evaluate the presence of neuroendocrine cells in ulcerative colitis and lymphocytic colitis and collagenous colitis. MATERIALS AND METHODS: Immunohistochemistry was performed to identify neuroendocrine cells through marker chromogranin A (CgA). The study included 10 cases of each diagnosis of Lymphocytic colitis, collagenous colitis and ulcerative colitis. RESULTS: There was statistically significant difference in the count of neuroendocrine cells, between lymphocytic colitis and control (p=0.019104), and between ulcerative colitis and controls (p=0.0077). In collagenous colitis there was an increase in neuroendocrine cells but we failed to find statistical differences. CONCLUSION: We could observe neuroendocrine cell hyperplasia in lymphocytic colitis and ulcerative colitis compared with controls, which confirm previous studies.
Assuntos
Colite Colagenosa/patologia , Colite Linfocítica/patologia , Colite Ulcerativa/patologia , Células Neuroendócrinas/patologia , Humanos , HiperplasiaRESUMO
Introducción: Colitis linfocítica y enteritis microscópica son causas relativamente comunes de diarrea crónica y ambas se caracterizan por un infiltrado linfocitico intraepitelial. No existen reportes previos de la coexistencia de ambas entidades. Objetivo: Describir las características clínicas e histológicas de los pacientes que presentan este diagnóstico simultáneamente. Material y métodos: Se seleccionaron pacientes adultos con diarrea crónica que tuvieran biopsia simultánea de colon y duodeno tomados el mismo día, durante los años 2010-2016, en el Servicio de Gastroenterología del Hospital Nacional Daniel Alcides Carrión. Se recopiló información clínica del archivo de historias. Las láminas fueron reevaluadas histológicamente por 3 patólogos. Se realizó estudio inmunohistoquímico de linfocitos intraepiteliales para CD8 y CD3 en 6 casos. Resultados: De 63 pacientes con diarrea crónica y biopsia simultánea de duodeno y colon, se identificó un total de 35 pacientes (55,5%) con diagnóstico simultáneo de enteritis microscópica y colitis linfocítica, 80% fueron mujeres. Se identificó anemia en 28,5% de los pacientes e infestación por Blastocystis hominis en el 31,8.%. En enteritis microscópica, el promedio de linfocitos intraepiteliales con CD8 y CD3 fue 40%, mientras que, en colitis linfocítica, el promedio fue de 37,2% para CD3 y 29,2% para CD8. En 11 de los 35 casos, se pudo obtener biopsias de íleon que fueron diagnosticadas como ileitis linfocítica. En 9 casos se diagnosticó colitis eosinofílica asociada a colitis linfocítica. Conclusión: Se encontró coexistencia de colitis linfocítica, enteritis microscópica y en algunos de ileitis linfocítica en un 55,5% pacientes con diarrea crónica con biopsia duodenal y colónica. Estos resultados abren la interrogante sobre si colitis linfocítica y enteritis microscópica son entidades diferentes o constituyen una sola patología que en algunos pacientes afecta varios segmentos del tubo digestivo.
Introduction: Lymphocytic colitis and microscopic enteritis are relatively common causes of chronic diarrhea and it is characterized by an intraepithelial lymphocytic infiltrate. There have been no previous reports of coexistence between these 2 pathologies. Objective: To describe histological and clinical characteristic in patients with coexistence of lymphocytic colitis and microscopic enteritis. Material and methods: All cases with simultaneous diagnosis of lymphocytic duodenosis and lymphocytic colitis were reevaluated during lapse time 2010-2016 in hospital Daniel Carrion. The slides were reviewed by 3 pathologists and clinical information was obtained from clinical records. Expression of CD3 and CD8 was detected in 6 cases by immunohistochemical assays. Results: A total of 35 patients with coexistence of lymphocytic duodenitis and lymphocytic colitis were selected of the pathology archives, 80% were females, Anemia was identified in 28.5% of patients. Blastocysitis hominis infestation was identified in 31.8%. The mean intraepithelial lymphocyte CD8 and CD3 positive was 40% in microscopic enteritis, while the mean intraepithelial lymphocyte CD3 positive was 37.2% and CD8 positive was 29.2% Additionally, lymphocytic ileitis was diagnosed in 11 of our cases. Eosinophilic colitis was diagnosed in 9 cases of lymphocytic colitis Conclusion: We found that lymphocytic colitis, microscopic enteritis and even lymphocytic ileitis can coexist in a group of patients with chronic diarrhea. These findings bring the question if this concurrence of both pathologies constituted a more generalized gastrointestinal disorder, involving both the large and the small intestines.
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Colite Microscópica/complicações , Colite Linfocítica/complicações , Diarreia/etiologia , Biópsia , Doença Crônica , Estudos Transversais , Estudos Retrospectivos , Infecções por Blastocystis/complicações , Infecções por Blastocystis/patologia , Colo/patologia , Colite Microscópica/patologia , Colite Linfocítica/patologia , Duodeno/patologia , Ileíte/complicações , Ileíte/patologia , Íleo/patologiaRESUMO
INTRODUCTION: Lymphocytic colitis and microscopic enteritis are relatively common causes of chronic diarrhea and it is characterized by an intraepithelial lymphocytic infiltrate. There have been no previous reports of coexistence between these 2 pathologies. OBJECTIVE: To describe histological and clinical characteristic in patients with coexistence of lymphocytic colitis and microscopic enteritis. MATERIAL AND METHODS: All cases with simultaneous diagnosis of lymphocytic duodenosis and lymphocytic colitis were reevaluated during lapse time 2010-2016 in hospital Daniel Carrion. The slides were reviewed by 3 pathologists and clinical information was obtained from clinical records. Expression of CD3 and CD8 was detected in 6 cases by immunohistochemical assays. RESULTS: A total of 35 patients with coexistence of lymphocytic duodenitis and lymphocytic colitis were selected of the pathology archives, 80% were females, Anemia was identified in 28.5% of patients. Blastocysitis hominis infestation was identified in 31.8%. The mean intraepithelial lymphocyte CD8 and CD3 positive was 40% in microscopic enteritis, while the mean intraepithelial lymphocyte CD3 positive was 37.2% and CD8 positive was 29.2% Additionally, lymphocytic ileitis was diagnosed in 11 of our cases. Eosinophilic colitis was diagnosed in 9 cases of lymphocytic colitis Conclusion: We found that lymphocytic colitis, microscopic enteritis and even lymphocytic ileitis can coexist in a group of patients with chronic diarrhea. These findings bring the question if this concurrence of both pathologies constituted a more generalized gastrointestinal disorder, involving both the large and the small intestines.
Assuntos
Colite Linfocítica/complicações , Colite Microscópica/complicações , Diarreia/etiologia , Adulto , Idoso , Biópsia , Infecções por Blastocystis/complicações , Infecções por Blastocystis/patologia , Doença Crônica , Colite Linfocítica/patologia , Colite Microscópica/patologia , Colo/patologia , Estudos Transversais , Duodeno/patologia , Feminino , Humanos , Ileíte/complicações , Ileíte/patologia , Íleo/patologia , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
The relationship between Microscopic Colitis and Inflammatory Bowel Disease is unclear. However, when both are diagnosed they seem to be part of a broader spectrum of the same disease, more than just a coincidence. We report a 55 years old woman with Ulcerative Colitis limited to the rectum with complete clinical and endoscopic response to standard treatment and adequate surveillance for 13 years, who abandoned treatment and control. After eight years, she consulted for mild-to-moderate non-bloody diarrhea lasting several months. Colonoscopy and basic laboratory did not show any alterations. Nevertheless, random biopsies had a characteristically pattern compatible with Lymphocytic Colitis. After the first week of treatment with budesonide the patient was asymptomatic and still in clinical remission, with negative fecal calprotectin at 6 months follow-up.
Assuntos
Colite Linfocítica/patologia , Colite Ulcerativa/patologia , Biópsia , Colonoscopia , Fezes/química , Feminino , Humanos , Doenças Inflamatórias Intestinais/complicações , Complexo Antígeno L1 Leucocitário/análise , Pessoa de Meia-IdadeRESUMO
The relationship between Microscopic Colitis and Inflammatory Bowel Disease is unclear. However, when both are diagnosed they seem to be part of a broader spectrum of the same disease, more than just a coincidence. We report a 55 years old woman with Ulcerative Colitis limited to the rectum with complete clinical and endoscopic response to standard treatment and adequate surveillance for 13 years, who abandoned treatment and control. After eight years, she consulted for mild-to-moderate non-bloody diarrhea lasting several months. Colonoscopy and basic laboratory did not show any alterations. Nevertheless, random biopsies had a characteristically pattern compatible with Lymphocytic Colitis. After the first week of treatment with budesonide the patient was asymptomatic and still in clinical remission, with negative fecal calprotectin at 6 months follow-up.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Colite Ulcerativa/patologia , Colite Linfocítica/patologia , Biópsia , Doenças Inflamatórias Intestinais/complicações , Colonoscopia , Complexo Antígeno L1 Leucocitário/análise , Fezes/químicaRESUMO
BACKGROUND: Colonoscopy is part of the current diagnostic armamentarium. However, in some patients with chronic diarrhea, a colonoscopy may show normal mucosa; in these cases, serial biopsies can provide important information for the diagnosis and treatment of patients. AIM: To analyze patients with chronic diarrhea having a macroscopically normal colonoscopy, by evaluating histological changes. METHODS: 30 patients with chronic diarrhea and normal colonoscopy were prospectively evaluated and submitted to serial biopsies of the terminal ileum, ascending colon and rectum. RESULTS: The sample of 30 patients showed a ratio of 18 men (60%) and 12 women (40%). On histological types, it was found that 13 patients (43.3%) had lymphoid hyperplasia, eosinophilic inflammation in 4 (13.3%), nonspecific inflammation in 4 (13.3%), regenerative changes in 3 (10%), lymphocytic colitis in 2 (6.6%) and changes consistent with Crohn's disease in 1 (3.3%). CONCLUSIONS: One can observe that even chronic diarrhea patients, without other associated factors, benefited from colonoscopy with biopsy, because it held the etiologic diagnosis in some cases as also excluded by histopathology. It was noticed that the frequency of patients with altered biopsy and less dragged diarrheal episodes (84.2%) was large, should consider their achievement.
INTRODUÇÃO: A colonoscopia faz parte do arsenal de diagnóstico atual. Porém, em alguns pacientes com diarreia crônica, a colonoscopia pode evidenciar mucosa normal; nesses casos biópsias seriadas podem trazer informações importantes para o diagnóstico e tratamento dos pacientes. OBJETIVO: Analisar pacientes com diarreia crônica submetidos à colonoscopia macroscopicamente normal, avaliando assim histologicamente as alterações. MÉTODOS: Análise prospectiva da histologia 30 pacientes com diarreia crônica e colonoscopias normais, submetidos a biópsias seriadas de íleo terminal, cólon ascendente e reto. RESULTADOS: A amostra de 30 pacientes mostrou uma proporção de 18 homens (60%) e 12 mulheres (40%). Sobre os tipos de alterações histológicas, foi verificado que 13 pacientes (43,3%) apresentaram hiperplasia linfóide, inflamação eosinofílica em 4 (13,3%), inflamação inespecífica em 4 (13,3%), alterações regenerativas em 3 (10%), colite linfocítica em 2 (6,6%) e alterações compatíveis com Doença de Crohn em 1 (3,3%). CONCLUSÕES: Observou-se que mesmo pacientes com diarreia crônica, sem outros fatores associados, beneficiaram-se da colonoscopia com biópsia, pois a mesma realizou o diagnóstico etiológico em alguns casos como também o excluiu através da histopatologia. Verificou-se que a frequência de pacientes com biópsia alterada e quadros diarreicos menos arrastados (84,2%) foi grande, devendo-se considerar a realização do exame.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Reto/cirurgia , Doença de Crohn/cirurgia , Pseudolinfoma , Colo Ascendente/cirurgia , Diarreia/diagnóstico , Diarreia/patologia , Reto/patologia , Doença de Crohn/patologia , Colonoscopia , Colo Ascendente/patologia , Colite Linfocítica , Diarreia/microbiologia , InflamaçãoRESUMO
La colitis linfocítica y la colitis colagenosa son las dos formas histológicas de la colitis microscópica (CM), condición médica reconocida hace más de 30 años, habitual en pacientes adultos con diarrea crónica acuosa, sin cambios endoscópicos en la mucosa del colon y cuyo diagnóstico se establece exclusivamente en el examenhistopatológico de las biopsias de colon. El objetivo de la presente revisión es familiarizar a los médicos patólogos quirúrgicos en práctica general con la morfología de la colitis linfocítica y la colitis colagenosa, así como con la importancia de los informes de patología y la de una buena comunicación con el médico endoscopista para el correcto diagnóstico de estas entidades, y brindar a estos pacientes el tratamiento adecuado.
Lymphocytic colitis and collagenous colitis are two histologic forms of microscopic colitis, a condition whichwas first recognized over 30 years ago. It is often found in adults with chronic, watery diarrhea although endoscopic examination of the colon is frequently normal. The diagnosis is based on microscopic examination of colonic biopsies. The aim of this review is to familiarize general surgical pathologists with the morphologic features of lymphocytic and collagenous colitis. In additional, this review emphasizes good communication with the endoscopist to allow correct recognition and ensure appropriate treatment.
Assuntos
Humanos , Masculino , Adulto , Feminino , Colite , Colite Colagenosa , Colite Linfocítica , Colite MicroscópicaRESUMO
OBJECTIVES: 1) To determine the prevalence of increased number of eosinophils in colonic mucosa of patients with lymphocytic colitis (LC). 2) To determine the coexistence of eosinophilic colitis (EC) in patients with lymphocytic colitis. MATERIALS AND METHODS: slides of adult patients with cronic diarrhea with diagnosis of LC were reviewed between October 2009 and March 2012. The number of eosinophils was quantified. RESULTS: Sixty eight patients with LC were included. Elevated eosinophils were found in 76.5 and in 51.4% a diagnosis of EC was established. CONCLUSION: 3 out of 4 patients with LC had elevated eosinophils and 1 of 2 patients with LC had criteria for EC.
Assuntos
Colite Linfocítica/complicações , Diarreia/complicações , Eosinofilia/complicações , Eosinofilia/patologia , Doença Crônica , Colite/complicações , Colite/patologia , Colite Linfocítica/patologia , Eosinófilos , Feminino , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-IdadeRESUMO
Objetivos: 1) Determinar la prevalencia de incremento de eosinófilos en mucosa colónica en pacientes con colitis linfocítica (CL). 2) Determinar la coexistencia de colitis eosinofílica (CE) en pacientes con CL. Materiales y métodos: Las biopsias colónicas de pacientes adultos con diarrea crónica diagnosticados como CL en el hospital Daniel A. Carrión durante octubre 2009 a marzo 2012 fueron revisadas de forma independiente por 2 patólogos. Microscópicamente, se investigó y cuantificó la presencia de eosinófilos en mucosa colónica. Resultados: Se incluyeron 68 casos de CL, de los cuales 76,5% tuvieron eosinófilos elevados en la mucosa colónica y en 51,4% se pudo hacer el diagnóstico de CE según los criterios establecidos. Conclusión: Tres de cuatro pacientes con CL presentan eosinófilos elevados y 1 de cada 2 pacientes con CL cumple criterios para CE.
Objectives: 1) To determine the prevalence of increased number of eosinophils in colonic mucosa of patients with lymphocytic colitis (LC). 2) To determine the coexistence of eosinophilic colitis (EC) in patients with lymphocytic colitis. Materials and methods: slides of adult patients with cronic diarrhea with diagnosis of LC were reviewed between October 2009 and March 2012. The number of eosinophils was quantified. Results: Sixty eight patients with LC were included. Elevated eosinophils were found in 76.5 and in 51.4% a diagnosis of EC was established. Conclusion: 3 out of 4 patients with LC had elevated eosinophils and 1 of 2 patients with LC had criteria for EC.
Assuntos
Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Colite Linfocítica/complicações , Diarreia/complicações , Eosinofilia/complicações , Eosinofilia/patologia , Doença Crônica , Colite Linfocítica/patologia , Colite/complicações , Colite/patologia , Eosinófilos , Contagem de LeucócitosRESUMO
OBJECTIVE: To report the colonoscopic and pathological findings in patients with chronic diarrhea from a gastroenterology unit during approximately 3 years in a general teaching hospital located in Lima-Peru. MATERIALS AND METHODS: Patients with chronic diarrhea as the motive for colonoscopy from March 2008 to December 2010 were selected from the colonoscopy report computerized database. Colonoscopic findings were registered. Biopsies taken during the procedure were prospectively reviewed. RESULTS: 226 patients were included, of which 162 (71.7%) had a colon biopsy available. The average age of the patients was 53.6±16.36. 85.8% of patients were reported to have a normal colon. 14.8% of patients were found to have a normal colonic mucosa or mucosal edema, 35.8% of patients had lymphocytic colitis and 28.4% had paucicelular colitis. CONCLUSIONS: The majority of colonoscopies were reported with unremarkable macroscopic findings. Lymphocytic colitis was unusually frequent compared to previous reports.
Assuntos
Colite Linfocítica/patologia , Colo/patologia , Diarreia/patologia , Mucosa Intestinal/patologia , Adulto , Idoso , Biópsia , Colite Linfocítica/diagnóstico , Colite Linfocítica/epidemiologia , Colite Linfocítica/cirurgia , Colo/cirurgia , Colonoscopia , Diarreia/diagnóstico , Diarreia/epidemiologia , Diarreia/cirurgia , Feminino , Humanos , Incidência , Mucosa Intestinal/cirurgia , Masculino , Pessoa de Meia-Idade , Peru/epidemiologia , Estudos ProspectivosRESUMO
BACKGROUND AND AIMS: The endoscopic aspect of the colorectal mucosa in those patients with collagenous colitis is usually normal, or with non-specific changes. Until now it had never been related to a mucosal pattern of mosaic type. Our aim was to determine the diagnostic accuracy of the presence of mosaic pattern in the colorectal mucosa for collagenous colitis. METHODS: Patients who had undergone a colonoscopy with random biopsies performed in the diagnostic evaluation of chronic diarrhea between 2004 and 2008 were studied. We defined patients with chronic diarrhea and mosaic mucosal pattern as "cases", and patients with chronic diarrhea without mosaic pattern as "controls". The odds ratio (OR) of finding a collagenous colitis in view of a mosaic pattern in colon was determined; as well as sensitivity and specificity; positive and negative likelihood ratios (LR+, LR-), considering this finding as a diagnostic instrument for collagenous colitis. RESULTS: 252 patients who had undergone colonoscopy with biopsy due to chronic diarrhea were analyzed. In 6 patients, a mosaic pattern was identified in the colorectal mucosa. The histological diagnose of 36 of the 252 patients (14%) was microscopic colitis, 27 of which (11%) had collagenous colitis. The colonoscopy was found normal in 21 of these 27 patients; in 2 patients, congestion or petechiae was found in the rectum; and in 4 patients (15%), all women, a mosaic pattern was found in the rectosigmoid mucosa. The OR of this finding was 19.4 (CI 95% 3.9-95.4) for collagenous colitis. It had a sensitivity of 14.8% (CI 95% 6.8-20), a specificity of 99.1% (CI 95% 98.2-99.7), LR+ of 16.6 (CI 95% 3.7-76.4), and LR- of 0.86 (CI 95% 0.80-0.95) for a collagenous colitis. CONCLUSION: The mosaic pattern in the colorectal mucosa of patients studied due to chronic diarrhea could be a distinguishing feature of collagenous colitis.
Assuntos
Colite Colagenosa/patologia , Colo/patologia , Colonoscopia , Mucosa Intestinal/patologia , Reto/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Estudos de Casos e Controles , Criança , Colite Linfocítica/patologia , Diagnóstico Diferencial , Feminino , Humanos , Funções Verossimilhança , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Retrospectivos , Sensibilidade e Especificidade , Adulto JovemRESUMO
Collagenous gastritis (CG) is an exceptional disease characterized by the deposition of subepithelial collagen band thicker than 10 tm in association with increased inflammatory cell infiltrate of the lamina propria. These histological features seem to overlap with other "collagenous enterocolitides". The pathogenesis and prognosis of CG still remains unclear. CG presentation is seen completely different in two major subsets of patients, children and adults. We report a 38 year-old man with abdominal pain and chronic diarrhea. The upper endoscopy showed a severe gastritis with biopsies that revealed CG, and the colonoscopy was normal with biopsies indicative of collagenous colitis. This characteristic form of clinical presentation in adult patients suggests that subepithelial collagen deposition may be a generalized disease affecting different areas of the gastrointestinal tract. The patient was treated with proton-pump-inhibitors and budesonide, with clinical improvement.
La gastritis colágena (GC) es una enfermedad poco frecuente caracterizada por el depósito subepitelial de colágeno de grosor mayor de 10 um asociado a infiltrado inflamatorio en la lámina propia. Estos hallazgos histológicos son similares a los encontrados en la enterocolitis colágena. La patogénesis y pronóstico de la GC permanece aún desconocida. La presentación clínica de la GC se observa de manera diferente en dos subgrupos de pacientes, niños y adultos. Se presenta el caso de un hombre de 38 años con dolor abdominal y diarrea crónica. La endoscopia digestiva alta mostró una gastritis severa con biopsias que revelaron la presencia de GC y la colonoscopia fue normal con biopsias que mostraron una colitis colágena. Esta forma de presentación clínica en el paciente adulto sugiere que el depósito de colágena subepitelial corresponde a una enfermedad generalizada que puede afectar a diferentes áreas del tracto gastrointestinal. El paciente fue tratado con inhibidores de la bomba de protones y budesonida con mejoría clínica.
Assuntos
Humanos , Masculino , Adulto , Colite Colagenosa/diagnóstico , Colite Colagenosa/patologia , Gastrite/diagnóstico , Gastrite/patologia , Anti-Inflamatórios/uso terapêutico , Budesonida/uso terapêutico , Colite Colagenosa/tratamento farmacológico , Colite Linfocítica/diagnóstico , Doença Celíaca/diagnóstico , Gastrite/tratamento farmacológico , Inibidores da Bomba de Prótons/uso terapêutico , Mucosa Gástrica/patologiaRESUMO
Antecedentes y objetivos: pretende demostrar la prevalencia de la colitis colagenosa y la linfocítica en pacientes con diarrea crónica, y describir las diferencias clínicas e histológica de ambas entidades que las hacen únicas materiales: se confirmó las características clínicas e histológicas, de pacientes con colitis colagenosa y linfocítica, confirmadas por un patólogo. Resultados: se confirmó el diagnóstico histológico de colitis colagenosa y colitis linfocítica en 19 y 16 pacientes respectivamente. En 22% de los pacientes con colitis colagenosa se describieron hallazgos histológicos que se superpusieron con los de colitis linfocítica, mientras que el 25% de los pacientes con colitis linfocítica tuvieron un incremento de su banda colágena. Ambas entidades mostraron uniformidad en cuanto a las características de la edad, los antecedentes de ingestión de AINE, las enfermedades autoinmunes intercurrentes, la diarrea y el dolor abdominal. Para ambos grupos predominó el compromiso en mujeres; sin embargo, es más notorio este compromiso en mujeres con colitis colagenosa (relación 21:79) que con la linfocítica (relación 44:569 (p=0,043). No se encontró una relación con el consumo de algún fármaco en especial, que pudieses estar relacionado con la aparición de estas entidades. La duración promedio de los síntomas antes del diagnóstico fue de ocho semanas para la colitis linfocítica y de 14 semanas para la colitis colagenosa (p=0,06). El pronóstico, en general, es buenos para ambas entidades, con una respuesta del 33% en la colitis colagenosa y sólo del 63% en la colitis linfocítica (p=0,03). Conclusiones: la colitis linfocítica y la colagenosa son entidades similares pero no idénticas. Los pacientes con colitis linfocítica son más jóvenes y con un tiempo menor de evolución de la entidad. Los síntomas son más leves y más fáciles de controlar en la colitis linfocítica. No se encontraron fármacos que estuvieran relacionados con esta entidad.
Background and aims: we evaluated the prevalence of lymphocytic and collagenous colitis in patients with chronic diarrhea. It is not known whether lymphocytic colitis and collagenous colitis represent different clinical entities or constitute part of spectrum of the same 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 19 patients with collagenous colitis and 16 with lymphocytic colitis. Twenty two per cent of patients with collagenous colitis and 25% of patients with lymphocytic colitis had overlapping but less pronounced histological features. Both groups were equal in terms of age, use of non-steroidal anti-inflammatory drugs, associated autoimmune conditions, arthritis, diarrhea and abdominal pain. The male to female ratio was 21:79 for collagenous colitis and 44:56 for lymphocytic colitis (p=0.043). Mean duration of symptoms before diagnosis was eight weeks for lymphocytic colitis and 14 weeks for collagenous colitis (p=0,06). Overall prognosis was generally mild; 63% of patients with lymphocytic colitis and 33% of patients with collagenous colitis reported resolution or significant improvement (p=0.03). Conclusions: collagenous and lymphocytic colitis are similar but not identical. Patients with lymphocytic colitis present somewhat earlier and younger patients. Symptoms are milder and more likely to disappear in lymphocytic colitis. We did not find any drugs inducing colitis.
Assuntos
Humanos , Colite Colagenosa , Colite Linfocítica , Colonoscopia , DiarreiaRESUMO
La Colitis microscopic, ahora Síndrome, abarca dos entidades relativamente nuevas para nosotros, la colitis linfocítica y la colitis colágenos, y se describen desde hace casi 25 años en Norteamérica y Europa. Estas patologías, se cree son variaciones del espectro clínico de la enfermedad inflamatoria intestinal y son causa importante de morbilidad en pacientes ancianos.
The «Colitides¼, includes two relatively new entities for us, linfocytic and colagenous colitis, described almost 25 years ago in North America and Europe. These entities, considered variations of the wide pathologic and clinical spectrum of inflammatory bowel disease are important cause of morbidity among old population.