COLLAGENOUS COLITIS - PATHOGENESIS AND MANAGEMENT

INTRODUCTION: Collagenous colitis is a rare disease of unknown etiolog y that primarily affects middle-aged women. It presents with chronic w atery diarrhea and thickening of the subepithelial collagen layer of t he colonic mucosa in the absence of endoscopic abnormalities. PURPOSE: This study was undertaken to review the current literature on clinica l course, pathology, diagnosis, and current management of collagenous colitis. RESULTS: Collagenous colitis is an inflammatory disease of th e colon, clinically characterized by a waxing and waning course of wat ery diarrhea, an inflammatory infiltration of the colonic mucosa, and a thickening of the subepithelial collagen layer. Its pathogenesis rem ains unclear, but there is evidence for an inflammatory process trigge red possibly by an uncommon luminal agent. Diagnosis is established by colonic biopsies; in the setting of normal colonic mucosa, the disord er is primarily managed medically with virtually no role for surgery. CONCLUSIONS: Pathogenesis of collagenous colitis remains unclear. Curr ent data favor an inflammatory etiology, possibly involving an initiat ing luminal insult. Guidelines for diagnosis are being established, an d medical treatment options are variably effective in the majority of cases. Very unusual refractory cases may benefit from surgical managem ent.