1.Microscopic Colitis.
Han Seung RYU ; Suck Chei CHOI
Korean Journal of Medicine 2015;89(6):663-671
Microscopic colitis (MC) is a chronic idiopathic inflammatory bowel disease presenting with chronic watery diarrhea. Epidemiologic studies from Western countries have demonstrated that it is almost as common as other classic inflammatory bowel diseases, such as Crohn's disease and ulcerative colitis. Histological examination can confirm the diagnosis and differentiate between the two main subtypes of MC: collagenous colitis and lymphocytic colitis. The pathophysiology of MC remains unknown; however, possible etiologies include genetic predispositions, autoimmunity, inflammatory responses to luminal factors such as certain drugs or bacteria, and myofibroblast dysregulations. The aim of MC therapy should take into account the severity of symptoms, impact on quality of life, and evidence from clinical trials of available medical treatments.
Autoimmunity
;
Bacteria
;
Colitis, Collagenous
;
Colitis, Lymphocytic
;
Colitis, Microscopic*
;
Colitis, Ulcerative
;
Crohn Disease
;
Diagnosis
;
Diarrhea
;
Epidemiologic Studies
;
Genetic Predisposition to Disease
;
Inflammatory Bowel Diseases
;
Myofibroblasts
;
Phenobarbital
;
Quality of Life
2.Microscopic Colitis: The Pathologic Features of 24 Korean Patients.
Sun Ah LEE ; Min Jung KANG ; Sung Ae JUNG ; Heasoo KOO
Korean Journal of Pathology 2009;43(2):133-138
BACKGROUND: The clinical presentation of microscopic colitis (MC) consists of chronic non-bloody watery diarrhea for weeks or months at a time, abdominal pain, and changes in bowel habits with a normal mucosal appearance upon performing colonoscopy. MC includes two relatively well established histopathologic entities: collagenous colitis (CC) and lymphocytic colitis (LC) as well as atypical forms. The recognition of the microscopic findings of this heterogeneous entity is very important for making the correct diagnosis and providing proper treatment. METHODS: We studied the colonoscopic biopsy specimens that were obtained from 26 patients who had clinical findings that were suggestive of MC. RESULTS: Fifteen patients (M:F=9:6) and 9 patients (M:F=5:4) showed the microscopic features of LC and MC, not otherwise specified, respectively. CONCLUSIONS: The clinicopathologic findings (the incidence of the subtypes, the patients' ages and the male/female ratio) of the 24 cases of MC in this study showed differences from the previously reported findings from other countries. Further studies with a sufficient number of patients from multi-centers would be necessary to confirm the regional or ethnic influence.
Abdominal Pain
;
Biopsy
;
Colitis, Collagenous
;
Colitis, Lymphocytic
;
Colitis, Microscopic
;
Colonoscopy
;
Diarrhea
;
Humans
;
Incidence
;
Lymphocyte Count
3.Prevalence, Pathogenesis, Diagnosis, and Management of Microscopic Colitis.
Gut and Liver 2018;12(3):227-235
Microscopic colitis (MC), which is comprised of lymphocytic colitis and collagenous colitis, is a clinicopathological diagnosis that is commonly encountered in clinical practice during the evaluation and management of chronic diarrhea. With an incidence approaching the incidence of inflammatory bowel disease, physician awareness is necessary, as diagnostic delays result in a poor quality of life and increased health care costs. The physician faces multiple challenges in the diagnosis and management of MC, as these patients frequently relapse after successful treatment. This review article outlines the risk factors associated with MC, the clinical presentation, diagnosis and histologic findings, as well as a proposed treatment algorithm. Prospective studies are required to better understand the natural history and to develop validated histologic endpoints that may be used as end points in future clinical trials and serve to guide patient management.
Colitis
;
Colitis, Collagenous
;
Colitis, Lymphocytic
;
Colitis, Microscopic*
;
Diagnosis*
;
Diarrhea
;
Health Care Costs
;
Humans
;
Incidence
;
Inflammatory Bowel Diseases
;
Natural History
;
Prevalence*
;
Prospective Studies
;
Quality of Life
;
Recurrence
;
Risk Factors
4.Clinical Characteristics of Microscopic Colitis in Korea: Prospective Multicenter Study by KASID.
Young Sook PARK ; Dae Hyun BAEK ; Won Ho KIM ; Joo Sung KIM ; Suk Kyun YANG ; Sung Ae JUNG ; Byung Ik JANG ; Chnag Hwan CHOI ; Dong Soo HAN ; Young Ho KIM ; Yong Woo CHUNG ; Sang Woo KIM ; You Sun KIM
Gut and Liver 2011;5(2):181-186
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.
Abdominal Pain
;
Autoimmune Diseases
;
Biopsy
;
Colitis, Collagenous
;
Colitis, Lymphocytic
;
Colitis, Microscopic
;
Collagen
;
Colon
;
Colon, Ascending
;
Colon, Transverse
;
Colonoscopy
;
Diarrhea
;
Humans
;
Loperamide
;
Mucous Membrane
;
Prevalence
;
Prospective Studies
;
Weight Loss
5.Microscopic colitis in a single center study: clinical feature & characteristics.
Se Young LEE ; Seong Woo JEON ; Yun Jin CHUNG ; Young Dae PARK ; Seok Jin YOON ; Soo Young PARK ; Eun Su KIM ; Min Kyu JUNG ; Sung Kook KIM ; Yong Hwan CHOI ; Chang Min CHO ; Won Young TAK ; Young Oh KWEON
Korean Journal of Medicine 2008;74(4):397-402
BACKGROUND/AIMS: Collagenous colitis (CC) and lymphocytic colitis (LC) are characterized by chronic diarrhea and normal radiologic and endoscopic findings. These are currently not uncommon entities whose incidence in increasing as more clinicians take biopsies from macroscopically normal colons. The purpose of this study was to examine the clinical features and characteristics in microscopic colitis. METHODS: From January 2003 to December 2006, medical records were reviewed from 80 patients with chronic diarrhea, who had normal colonoscopic findings but underwent biopsy. Patients with microscopic colitis were identified by reviewing the pathology databases and by reviewing biopsies. RESULTS: Microscopic colitis was diagnosed in 12 patients (15%). Six patients with CC (Male:Female=2:4, mean age 54+/-20.1 years) and 6 patients with LC (Male:Female=5:1, mean age 51.2+/-21.4 years) were identified. Autoimmune disease was diagnosed in 4 patients (33%). Drug-induced disease was suspected in 3 patients (25%). The inciting drugs were NSAIDs, ticlopidine, ranitidine, and acarbose. Complete or partial resolution of diarrhea was achieved in all patients, including spontaneous resolution in 2 patients. Antidiarrheal drugs, mesalazine, and cholestylamine were highly effective in both diseases. Recurrence of symptoms occurred in 2 patients (17%). They are taking medicine at present. CONCLUSIONS: Microscopic colitis is a relatively common cause of chronic diarrhea that appears to be increasing in incidence. We reported clinical features, characteristics, treatment, and response of microscopic colitis in our experience.
Acarbose
;
Anti-Inflammatory Agents, Non-Steroidal
;
Antidiarrheals
;
Autoimmune Diseases
;
Biopsy
;
Colitis, Collagenous
;
Colitis, Lymphocytic
;
Colitis, Microscopic
;
Colon
;
Diarrhea
;
Humans
;
Incidence
;
Medical Records
;
Mesalamine
;
Ranitidine
;
Recurrence
;
Ticlopidine
6.Pharmacologic Agents for Chronic Diarrhea.
Intestinal Research 2015;13(4):306-312
Chronic diarrhea is usually associated with a number of non-infectious causes. When definitive treatment is unavailable, symptomatic drug therapy is indicated. Pharmacologic agents for chronic diarrhea include loperamide, 5-hydroxytryptamine type 3 (5-HT3) receptor antagonists, diosmectite, cholestyramine, probiotics, antispasmodics, rifaximin, and anti-inflammatory agents. Loperamide, a synthetic opiate agonist, decreases peristaltic activity and inhibits secretion, resulting in the reduction of fluid and electrolyte loss and an increase in stool consistency. Cholestyramine is a bile acid sequestrant that is generally considered as the first-line treatment for bile acid diarrhea. 5-HT3 receptor antagonists have significant benefits in patients with irritable bowel syndrome (IBS) with diarrhea. Ramosetron improves stool consistency as well as global IBS symptoms. Probiotics may have a role in the prevention of antibiotic-associated diarrhea. However, data on the role of probiotics in the treatment of chronic diarrhea are lacking. Diosmectite, an absorbent, can be used for the treatment of chronic functional diarrhea, radiation-induced diarrhea, and chemotherapy-induced diarrhea. Antispasmodics including alverine citrate, mebeverine, otilonium bromide, and pinaverium bromide are used for relieving diarrheal symptoms and abdominal pain. Rifaximin can be effective for chronic diarrhea associated with IBS and small intestinal bacterial overgrowth. Budesonide is effective in both lymphocytic colitis and collagenous colitis. The efficacy of mesalazine in microscopic colitis is weak or remains uncertain. Considering their mechanisms of action, these agents should be prescribed properly.
Abdominal Pain
;
Anti-Inflammatory Agents
;
Bile
;
Budesonide
;
Cholestyramine Resin
;
Citric Acid
;
Colitis, Collagenous
;
Colitis, Lymphocytic
;
Colitis, Microscopic
;
Diarrhea*
;
Drug Therapy
;
Humans
;
Irritable Bowel Syndrome
;
Loperamide
;
Mesalamine
;
Parasympatholytics
;
Probiotics
;
Receptors, Serotonin, 5-HT3
;
Serotonin
7.E-cadherin Expression in Colonic Epithelium of Various Colitis in Children.
Na Young LEE ; Do Youn PARK ; Jae Hong PARK
Korean Journal of Pediatric Gastroenterology and Nutrition 2009;12(2):177-182
PURPOSE: Colitis is a condition associated with a spectrum of altered morphologic changes and cellular adhesion. E-cadherin plays a key role in the establishment and maintenance of epithelial tissue structure and cell-cell adhesion. The purpose of this study is to evaluate E-cadherin expression in colonic epithelium of various colitis in children. METHODS: The expressions of E-cadherin were examined in 39 cases of colonic mucosal biopsy specimen using immunohistochemical staining. When more than 50 percent of cells exhibited uniformly the same intensity and pattern of immunostaining as the adjacent normal mucosa, the antigen expression was considered normal. Abnormal expression was defined when less than 50 percent of cells stained, when cells showed a heterogeneously weak or altered distribution, or when complete absence of staining was observed. RESULTS: Fifteen cases with non-specific colitis (38.5%), 7 cases of with Crohn's disease (17.9%), 5 cases of infectious colitis and milk protein sensitive proctocolitis (12.8%), 3 cases of ulcerative colitis (7.7%), 2 cases of Henoch-Schonlein purpura colitis (5.1%), one case of Behcet's disease and ischemic colitis (2.6%) were included in this study. E-cadherin expression was decreased in all kinds of colitis. Reduced expression of E-cadherin was observed in 77 percent of cases. E-cadherin was weaker or no expression in reparative epithelium and "ulcer associated cell lineage". CONCLUSION: Altered expression of E-cadherin occurs during mucosal inflammation in any kinds of colitis. These changes may be involved in promoting cell migration during epithelial restitution of the gastrointestinal mucosa.
Biopsy
;
Cadherins
;
Cell Movement
;
Child
;
Colitis
;
Colitis, Ischemic
;
Colitis, Ulcerative
;
Colon
;
Crohn Disease
;
Epithelium
;
Humans
;
Inflammation
;
Milk Proteins
;
Mucous Membrane
;
Proctocolitis
;
Purpura, Schoenlein-Henoch
8.Is Microscopic Colitis Really Microscopic?.
Young Sook PARK ; Tae Kyun KIM
Gut and Liver 2015;9(2):137-138
No abstract available.
Colitis, Collagenous/*pathology
;
Colitis, Lymphocytic/*pathology
;
*Colonoscopy
;
Female
;
Humans
;
Intestinal Mucosa/*pathology
;
Male
9.Is Microscopic Colitis Really Microscopic?.
Young Sook PARK ; Tae Kyun KIM
Gut and Liver 2015;9(2):137-138
No abstract available.
Colitis, Collagenous/*pathology
;
Colitis, Lymphocytic/*pathology
;
*Colonoscopy
;
Female
;
Humans
;
Intestinal Mucosa/*pathology
;
Male
10.Analysis of 15 Cases of Ischemic Colitis Induced by Increased Abdominal Pressure.
Sang Bok CHA ; Soo Heon PARK ; Se Hyun CHO ; Gyu Yong CHOI ; Sung Bae MOON ; Myung Hoon KIM ; Gi Bum KIM ; Sang Soo BAE ; Whan Seok CHO ; Won Hee HAN
Korean Journal of Gastrointestinal Endoscopy 1996;16(6):952-961
It was suggested that temporary vascular insufficiency within the wall of the colon causes iachemic colitis. So, motivated by this fact, we studied and analyzed 15 cases of iachemic colitis, which were confirmed by the diagnostic criteria of Nagasako(1982), through 32 months from January, 1993 to August, 1995 at Our Lady of Mercy Hospital, Incheon.(continue...)
Colitis
;
Colitis, Ischemic*
;
Colon