Collagenous colitis. A study of 11 cases

Background. - Collagenous colitis (CC) is a rare large bowel inflammatory d isorder. The aim of this retrospective study was to analyze extra-digestive manifestations of CC, associated systemic diseases, clinical course and re sponse to therapeutic regimens. Patients et Methods. - Between 1989 and 1999, eleven patients were diagnose d as having CC, in two Departments of Internal Medicine and Gastroenterolog y, on the basis of usual criteria: chronic watery diarrhea, endoscopic exam ination showing normal findings and subepithelial collagen band thicker tha n 10 mum. Results. - Ten women and one man, age 39 to 88 years (mean: 66.6), had had their diarrhea for I to 240 months before diagnosis (mean: 48). Associated extra-digestive manifestations were: weight loss (3 cases out of 11), infla mmatory arthralgia (4 cases), fever (2 cases), pelvispondylitis (2 cases), autoimmune thyroiditis (2 cases), and Sharp syndrome (I cases). Laboratory abnormalities were: inflammatory syndrome (3 cases), anemia (5 cases), hypo gammaglobulinemia (3 cases), and hypoalbuminemia (4 cases). Stool cultures and parasite examination were negative in all patients. Therapy used succes sively for CC until resolution of chronic diarrhea (uncontrolled with sympt omatic treatment) was: sulfasalazine in 7 patients (beneficial (B) in 5 out of 7), 5-aminosalicylic acid in 6 (B: 2/6), corticosteroids in 2 (B: 2/2), azathioprine in I (B: 1/1). After a mean follow-up of 18 months (range: 1- 72), resolution of CC was observed in 8 out of 11 patients. Discussion. - Mean characteristics of CC were: female predominance (91%), p resence of extra-digestive manifestations (36%); mucosal inflammation with subepithelial collagen band and frequent association to rheumatic or autoim mune diseases suggest an immune basis for CC. Usefulness of systematic colo n biopsies is underlined. Clinical course is often favorable with sulfasala zine and 5-aminosalicylate acid. Corticosteroids are rarely used.