Microscopic colitis

Colonic neoplasia Ulcerative and Crohn s colitis Microscopic colitis Small bowel ... 

Approximately 8% to 20% of patients with UC and 7% to 26% of patients with CD are elderly at initial diagnosis.42 In general, IBD presents similarly in elderly patients compared to younger individuals. Elderly patients may have more comor-bid diseases, some of which may make the diagnosis of IBD more difficult. Such conditions include ischemic colitis, diverticular disease, and microscopic colitis. Increased age is also associated with a higher incidence of adenomatous polyps, but the onset of IBD at an advanced age does not appear to increase the risk of developing colorectal cancer. Elderly patients may also use more medications, particularly NSAIDs, which may induce or exacerbate colitis. 

Fig. 1. Typical presentation of pseudomembranous colitis. At endoscopy (left), the mucosal surface of the colon appears hyper-emic and almost completely covered by a yellow-green exudate. The mucosa itself is somewhat eroded. Microscopically (right), the pseudomembrane is composed of inflammatory cells, necrotic epithelium, and mucus in which the overgrowth of microorganisms usually takes place. 

Schiller L R 2000 Pathogenesis and treatment of microscopic-colitis syndrome. Lancet 355 1198-1199... 

Bismuth salts are still in use. Tripotassium dicitrato-bismuthate and bicitropeptide (a bismuth-peptide complex) are used in the eradication of Helicobacter pylori in combination with antibiotics (SEDA-21,233) (1 ), and ranitidine bismuth citrate is used to treat peptic ulcer (5). Bismuth salicylates are used in other intestinal diseases, such as microscopic colitis (6,7) and collagenous colitis (8). Bismuth subnitrate plus iodoform is used to pack surgical cavities. Bismuth oxide and bismuth subgallate are found in some topical formulations that are used for treating hemorrhoids. Bismuth is also used topically as a bacteriostatic. 

Fine KD, Lee EL. Efficacy of open-label bismuth subsalicylate for the treatment of microscopic colitis. Gastroenterology 1998 114(l) 29-36. 

Schiller LR. Microscopic colitis syndrome lymphocytic cohtis and collagenous colitis. Semin Gastrointest Dis 1999 10(4) 145-55. 

Mild and transient gastrointestinal disorders, namely nausea, vomiting, diarrhea or anorexia, were observed in 30-40% of patients, and their severity is typically dose-related (20). Dryness or inflammation of the oropharynx, and moderate stomatitis were sometimes noted, but severe painful oral ulcers recurring after interferon alfa re-administration have been reported (241). More severe forms of digestive disease have been described in isolated case histories with microscopic colitis and the occurrence or the exacerbation of ulcerative colitis (SED-13, 1094) (SEDA-21, 372). 

Microscopic colitis and new or worsened ulcerative colitis have been attributed to interferon alfa (SED-13, 1094) (SEDA-21,372). Ischemic colitis has been reported in two of 280 patients treated for chronic hepatitis C (245). 

Figueroa-Quintanilla D, Salazar-Lindo E, Sack R B et al 1993 A controlled trial of bismuth subsalicylate in infants with acute watery diarrheal disease. New England Journal of Medicine 328 1653-1658 Fine K D, Lee E L 1998 Efficacy of open-label bismuth subsalicylate for the treatment of microscopic colitis. Gastroenterology 114 29-36... 

Gastrointestinal The possible association between microscopic colitis and the use of proton pump inhibitors has been investigated retrospectively in a case-control study in 95 patients with microscopic colitis and 95 age- and sex-matched controls [48 ]. There was significantly more exposure to proton pump inhibitors at the time of... 

Gastrointestinal Of 8 patients with microscopic colitis, either lymphocytic (n = 7) or collagenous ( = 1), during treatment with lansoprazole, most were women and all were older than 60 years [57 ]. None had a history of neoplastic disorders and all were negative for celiac disease antibodies. In most cases, the symptoms started within a few weeks (median 22, range 5-180 days). In all cases, both chronological and causality likelihood scores supported a causative role of lansoprazole. In particular, withdrawal of lansoprazole and substitution of other proton pump inhibitors was followed by resolution of the bowel disorder (median 7, range 4-15 days), without need for further treatment. All were followed up for at least 4 months without symptom recurrence. 

Microscopic lymphocytic and collagenous colitis can occur with other proton pump inhibitors, although they are more frequent with lansoprazole [48 ]. 

Keszthelyi D, Jansen SV, Schouten GA, de Kort S, Scholtes B, Engels LG, Masclee AA. Proton pump inhibitor use is associated with an increased risk for microscopic colitis a case-control study. Aliment Pharmacol Ther 2010 32 1124—8. 

Pascua MF, Kedia P, Weiner MG, Holmes J, Ellenberg J, Lewis JD. Microscopic colitis and medication use. Clin Med Insights Gastroenterol 2010 2010 11-9. 

Di Giulio E, Delle Fave G. Lansoprazole-induced microscopic colitis an increasing problem Results of a prospective case-series and systematic review of the literature. Dig Liver Dis 2011 43 380-5. 

Gastrointestinal In the acetic acid-induced colitis rat model for inflammatory bowel disease, lithium 20 mg/kg given 1 hour before the acetic acid ameliorated the macroscopic and microscopic gut abnormalities, including reduced neutrophil infiltration, reduced myeloperoxidase activity, and reduced lipid peroxidation [73 ]. 

Gastrointestinal Lansoprazole has been associated with diarrhea and microscopic colitis, but this association has not been clearly established with other proton pump inhibitors. Microscopic colitis has been reported after treatment with esomeprazole (two cases) and omeprazole (two cases) [57 ]. 

Gastrointestinal Two cases of microscopic colitis associated with omeprazole have been reported [57 ]. 

Lesions. Microscopic changes include intestinal submucosal and muscular hemorrhage, hepatic fatty change, thymic hypoplasia, interstitial myocarditis, endocarditis, and colitis. 

Munch A, Aust D, Bohr J, Bonderup O, Fernandez Banares F, Hjortswang H, et al. Microscopic colitis current status, present and future challenges statements of the European Microscopic GoHtis Group. J Grohns Colitis 2012 6(9) 932 5. 

Fulcrand J, Auffret M, Lacour A, Gouraud A, Gautier S. CoKte microscopique chez un patient traite par duloxetine. [Microscopic colitis in a patient treated with duloxetine] Therapie 2013 68(5) 329-31. 

Bahin FF, Chu G, Rhodes G. Development of microscopic colitis secondary to duloxetine. J Clin Gastroenterol 2013 47(l) 89-90. 

A 16-year-old boy taking mesalazine (1.2 g, once daily) for the past 3 years to treat his ulcerative colitis reported two separate episodes of red-brown-appearing urine. Urine samples collected on the following day of each episode revealed normal macro- and microscopic patterns. The only other recent medication was a daily multivitamin preparation with iron. The patient had noted that his urine developed the abnormal colour only after contact with toilet water at home. The toilet had recently been cleaned with a solution containing sodium hypochlorite, the active ingredient in household bleach. A normal urine sample, collected from another 15-year-old boy with ulcerative colitis under therapy with oral mesalazine (400 mg, three times daily), was then mixed with 2 mL of commercial sodium hypochlorite bleach and a red-brown discoloration developed spontaneously [90 ]. 

Konijeti GG, Deshpande V, Bunker CJ. An unusual case of chronic diarrhea. Lansoprazole-induced microscopic colitis. Gastroenterology 2013 144 696-857. 

Figure 4.4 Histological sections ofthe colon showing the effects of oral nanocrystalline silver (NP) on a rat colitis model, where colitis was produced using a single intracolonic injection of dinitrobenzenesulfonic acid (DNBS). Treatment groups consisted of oral administration of nanosilver particles (40, 4 or 0.4 mg kg ) or sulfasalazine suspension. Placebo and untreated groups served as controls. Colonic sections were stained with hematoxylin and eosin and examined microscopically, (a) Treated with NP ...

The mechanism for the occasionally serious side effects of the lincomycins has not as yet been fully clarified. Electron microscopic studies of pseudomembranes from patients treated with clindamycin have revealed numerous particles with the ultrastruc-tural characteristics of virus. The suggestion has therefore been advanced that lincomycin-associated colitis may be a viral condition (54 ). However, also other mechanisms have been suggested. One of these is that fibrin microthrombi are present in rectal biopsies, suggesting that it is possible that capillary... 

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