Microscopic Colitis: Clinical Presentation, Treatment and Outcome of 494 Patients

Abstract

Background: Collagenous colitis (CC) and lymphocytic colitis (LC) are chronic disorders characterized by watery diarrhea.

Aim: To evaluate prospectively the clinical features, response to treatment and outcomes in a large group of patients with CC and LC.

Patients and Methods: Patients with histologically confirmed CC and LC were prospectively enrolled to complete a questionnaire on onset and duration of diarrhea, stool frequency and consistency, other gastrointestinal symptoms including weight loss, drug history, treatment success and concomitant diseases.

Results: A total of 494 patients (CC, n = 287, LC, n = 207) were available for analysis. The mean age at diagnosis was 65 in CC and 61 years in LC with a identically female predominance (76 % of patients) in both groups. Prior to diagnosis the mean duration of symptoms was 37 in CC and 23 months in LC. CC and LC patients share similar pattern of clinical symptoms. Concomitant autoimmune disorders were more common in CC patients (48.4 %) than in LC patients (29.6 %). Sustained clinical remission was reported by 35.5 % of CC and 38,6 % of LC, but more CC patients (47.7 %) received medication such as corticosteroids, antibiotics, bismuth or 5-aminosalicyclic than LC patients (16.9 %). 18.6 % of CC patients and 17.6 % of LC were regularly using NSAIDs.

Conclusion: Collagenous and lymphocytic colitis are frequently diagnosed in elderly female patients. CC and LC share similar symptom pattern, but concomitant autoimmune disease were more common in CC than in LC patients.

Zusammenfassung

Hintergrund: Die kollagene und lymphozytäre Kolitis zählt zu den chronisch-entzündlichen Darmerkrankungen mit dem Leitsymptom chronische wässrige Diarrhö.

Ziel: Wir untersuchten prospektiv klinische Parameter, Ansprechen auf medikamentöse Therapien und den klinischen Verlauf eines großen Patientenkollektivs mit kollagener (CC) und lymphozytärer (LC) Kolitis.

Patienten und Methoden: Bei Patienten mit histologisch nachgewiesener kollagener und lymphozytärer Kolitis wurden prospektiv anhand standardisierter Fragebögen folgende Parameter erfasst: Symptombeginn und Zeitpunkt der Diagnosestellung, Krankheitsdauer, Stuhlfrequenz und -konsistenz, andere gastrointestinale Symptome einschließlich Gewichtsverlust, Medikamenten-anamnese und Begleiterkrankungen sowie Ansprechen auf die Therapie.

Ergebnisse: Insgesamt 494 Patienten (CC, n = 287; LC, n = 207) waren für die Analyse auswertbar. Das mittlere Alter lag bei 65 in der CC- und 61 Jahren in der LC-Gruppe mit einem Anteil von 76 % Frauen in beiden Gruppen. Die Dauer der Symptomatik betrug vor Diagnosestellung durchschnittlich 37 (CC-Gruppe) und 23 Monate (LC-Gruppe). Die gastrointestinale Symptomatik von Patienten mit CC war der mit LC ähnlich. Begleitende Autoimmunerkrankungen wurden häufiger in der Gruppe mit CC (48,4 %) als mit LC (29,6 %) angegeben. Eine anhaltende klinische Remission wurde von 35,5 % in der CC und 38,6 % in der LC-Gruppe berichtet, aber Patienten mit CC (47,7 %) erhielten häufiger Medikamente wie z.B. Kortikosteroide, Antibiotika, Wismutsalicylat oder 5-Aminosalicylsäure (47,7 %) als Patienten mit LC (16,9 %). 18,6 % der CC- und 17,6 % der LC-Patienten wurden regelmäßig mit nichtsteroidalen Antirheumatika behandelt.

Diskussion: Die kollagene und lymphozytäre Kolitis ist eine Erkrankung des höheren Lebensalters der Frau. Beide Entitäten weisen eine ähnliche Symptomatik auf, die Autoimmunerkrankungen kommen jedoch häufiger bei Patienten mit CC vor.

Schlüsselwörter

Darm - kollagene Kolitis - chronisch entzündliche Darmerkrankung

Key words

intestine - collagenous colitis - chronic inflammatory bowel disease

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