Microscopic Colitis - Collagenous colitis 1
This 89-year-old white female reported a six-week history of watery diarrhea. Because of her advanced age, the patient was scheduled for colonoscopy on an inpatient basis. The patient took no medication with the exception of NSAIDs for multiple joint complaints.
Colonoscopy was unremarkable up to and including the cecum. Biopsies were obtained as the endoscope was withdrawn. In the distal descending colon and the sigmoid there were changes that were not present as the instrument was advanced. The videoclip shows several deep, blood-covered tears, probably reaching the submucosa. The examination was completed with minimal insufflation and complete aspiration of applied gas. The biopsies revealed findings consistent with collagenous colitis. Therapy with budesonide was started. No clinically apparent complications were observed.
The clinical cardinal symptom of collagenous colitis is chronic or intermittent watery diarrhea. The diagnosis is made histologically since the mucosa appears normal at endoscopy. There are rarely any complications reported and a connection with the use of NSAIDs is seldom. In individual cases, there may be increased vulnerability of the mucosa upon distention of the bowel, as occurs, for example, during colonoscopy. This appears to have been the case with the present patient.
Bonderup OK, Hansen JB, Birket-Smith L, Vestergaard V, Teglbjærg PS, Fallingborg J. Budesonide treatment of collagenous colitis: a randomised, double blind, placebo controlled trial with morphometric analysis. Gut. 2003;52:248-51.
(see also Videoclip 2)