Colonic ulcers accompanying collagenous colitis: implication of nonsteroidal anti-inflammatory drugs.
OBJECTIVE
A small minority of otherwise typical collagenous colitis (CC) patients also have mucosal ulceration (CC-U). We studied the association of CC-U cases with ingestion of nonsteroidal anti-inflammatory drugs (NSAIDs) as a possible explanation for the mucosal ulceration.


METHODS
Clinical information and histological features were reviewed in nine cases of biopsy-diagnosed CC-U. Biopsies from 18 unselected cases of CC without ulceration were reviewed for comparison.


RESULTS
Of nine patients with CC-U, seven (77.8%) had a history of NSAID ingestion, compared with four of 18 CC controls (20.2%) (p = 0.006). The diarrhea resolved after cessation of NSAID use in four CC-U patients, partially resolved in one patient, and persisted in one patient. The outcome was not available in one patient. Of the two CC-U patients who did not use NSAIDs, one patient was taking lisinopril (angiotensin-converting enzyme inhibitor), and the diarrhea resolved after stopping the drug; the ulceration in the second patient was thought to be ischemic in origin.


CONCLUSIONS
Collagenous colitis with ulceration has a strong association with NSAID ingestion. Evaluation of medications and cessation of NSAIDs should be considered as a therapeutic option in cases of collagenous colitis with colonic ulceration.
Kakar
Sanjay
S
Department of Pathology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Pardi
Darrell S
DS
Burgart
Lawrence J
LJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D003092:Colitis / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D003113:Colonoscopy; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D014456:Ulcer / Q000139:chemically induced* / Q000150:complications* / Q000175:diagnosis
D000894:Anti-Inflammatory Agents, Non-Steroidal