title: Microscopic colitis: is it a spectrum of inflammatory bowel disease?
abstract: Lymphocytic and collagenous colitis are forms of microscopic colitis which typically presents in elderly patients as chronic watery diarrhea. The association between microscopic colitis and inflammatory bowel disease is weak and unclear. Lymphocytic colitis progressing to ulcerative colitis has been previously reported; however there is limited data on ulcerative colitis evolving into microscopic (lymphocytic or collagenous) colitis. We report a series of six patients with documented ulcerative colitis who subsequently were diagnosed with collagenous colitis or lymphocytic colitis suggesting microscopic colitis could be a part of the spectrum of inflammatory bowel disease. The median duration of ulcerative colitis prior to being diagnosed with microscopic colitis was 15 years. We noted complete histological and/or symptomatic remission in three out of six cases while the other three patients reverted back into ulcerative colitis suggesting lymphocytic or collagenous colitis could present as a continuum of ulcerative colitis. The exact molecular mechanism of this histological transformation or the prognostic implications is still unclear. Till then it might be prudent to follow up these patients to assess for the relapse of inflammatory bowel disease as well as for dysplasia surveillance.
authors.affiliation: Department of Gastroenterology and Hepatology, Digestive Disease Institute, Desk A30, Cleveland Clinic, Cleveland, OH 44195, United States.
authors.forename: Ramprasad
authors.initials: R
authors.lastname: Jegadeesan
authors.forename: Xiuli
authors.initials: X
authors.lastname: Liu
authors.forename: Mangesh R
authors.initials: MR
authors.lastname: Pagadala
authors.forename: Norma
authors.initials: N
authors.lastname: Gutierrez
authors.forename: Mujtaba
authors.initials: M
authors.lastname: Butt
authors.forename: Udayakumar
authors.initials: U
authors.lastname: Navaneethan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D046729:Colitis, Collagenous / Q000145:classification / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D046730:Colitis, Lymphocytic / Q000145:classification / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D003093:Colitis, Ulcerative / Q000145:classification / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D003106:Colon / Q000473:pathology*; D003113:Colonoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012008:Recurrence; D012074:Remission Induction; D013997:Time Factors; D016896:Treatment Outcome
keywords: Collagenous colitis; Inflammatory bowel disease; Lymphocytic colitis; Microscopic colitis; Ulcerative colitis