COLLAGENOUS COLITIS - A TREATABLE DISEASE WITH AN ELUSIVE DIAGNOSIS

Collagenous colitis is associated with normal endoscopy examination an d peculiar histopathological changes. The natural history and optimal treatment are not well defined. Our objectives were to analyze the sym ptomatology of collagenous colitis, determine the natural history, and response to treatment. All patients with collagenous colitis from 197 8 to 1992 were studied. Demographic data, symptomatology, associated c onditions, colonoscopic findings, and pathology specimens were reviewe d. Clinical improvement was classified as none, partial, or complete. Nineteen patients were identified, mainly white females over age 50. M ean follow-up was 22.6 months. Symptom duration was 37 months (range 4 months to 15 years). Symptoms were intermittent diarrhea (19), with a predominant nocturnal component (13); abdominal pain (15); and mild w eight loss and incontinence (8). Colonoscopy was normal in 12 patients . Segmental mucosal edema and loss of vasculature pattern were present in seven. Antiperistaltic agents were used in 17 patients with no imp rovement (15), partial resolution (1), and complete resolution (1). Ei ght nonresponders received sulfasalazine. Responses were none (6) or c omplete (2). Ten patients received steroids (10-20 mg/day). One failed to respond. Nine initially responded completely but two relapsed. Sev en patients who did not respond to any type of treatment improved even tually, two partially and five completely. These patients were younger (54.3 vs 68.3 years, P = 0.04) and symptom duration was shorter (25.4 vs 44.5 months, P = 0.38) than the rest of the patients. It is conclu ded that (1) nonspecific endoscopic abnormalities can be encountered i n collagenous colitis in 40% of the cases; (2) low-dose steroids are t he most effective treatment; (3) antiperistaltic agents and sulfasalaz ine are usually ineffective as primary therapy; and (4) collagenous co litis is a chronic, mild intermittent, and self-limited disease that, in some patients, can subside without treatment.