title: Colonic ulcers accompanying collagenous colitis: implication of nonsteroidal anti-inflammatory drugs.
abstract: 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.
authors.affiliation: Department of Pathology, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Kakar
authors.forename: Darrell S
authors.initials: DS
authors.lastname: Pardi
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Burgart
mesh_terms: 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
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal