GASTROENTEROLOGY ARTICLE OF THE WEEK

May 31, 2001

 Giardiello FM, Lazengy AJ.  The Atypical Colitides.  Gastroenterology Clin NA 1999;28(2):479-490.

 1.  Treatment of collagenous colitis should include

            a.  avoidance of caffeine, lactose containing foods and NSAID’s

            b.  bile salt binders may help some patients

            c.  bulk agents and anti-diarrheals are contraindicated

            d.  Peptobismol may help

            e.  5-ASA compounds can be used in patients not responding to conservative

measures.

 2.  Features of collagenous colitis include

            a.  painless diarrhea

            b.  weight loss

c.  subepithelial collagen band, chronic inflammation in the lamina propria and intraepithelial lymphocytes

d.  typical histologic findings are invariably found in rectal biopsies

e.  subepithelial collagen band without increased inflammatory infiltrate is not diagnostic for this condition

f.  absent or rare neutrophils 

True or False 

3.  Lack of short-chain fatty acids normally used by colonocytes as energy source, appears to be the cause of the mucosal abnormalities in diversion colitis.

 4.  Increased fluid secretion by intestinal epithelium plays an important role in the pathogenesis of diarrhea in collagenous colitis.

 5.  Crypt distortion is typically not seen in collagenous colitis. 

6.  Histologic findings in lymphocytic colitis are similar to those in collagenous colitis, except that the subepithelial collagen band is not present.

 7.  Cryptitis is a feature typical of ulcerative colitis and rarely if ever seen in collagenous colitis.

 8.  Bloody discharge from anus or mucous fistula in patients with bypassed segments of colon is not a typical finding of diversion colitis

 9.  Collagenous colitis affects primarily middle aged men and presents with bloody mucous diarrhea.

 10.  Nodularity and aphthous erosions and inflammatory polyps in a diverted segment of colon should raise the possibility of Crohn’s disease, as these findings are atypical for diversion colitis.

 11.  Yield of diagnosis in collagenous colitis is increased by targeting endoscopic biopsies to abnormal looking mucosa

 12.  Female predominance is not seen in lymphocytic colitis.

 13.  Histologic features of diversion colitis are very similar to inflammatory bowel disease, however, maintenance of normal crypt architecture is a relatively constant feature of diversion colitis.

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