title: Fecal stream diversion and mucosal cytokine levels in collagenous colitis: A case report.
abstract: In this case report, we examined the levels of cytokines expressed before and during fecal stream diversion and after intestinal continuity was restored in a patient with collagenous colitis. We report the case of a 46-year-old woman with chronic, active collagenous colitis who either failed to achieve clinical remission or experienced adverse effects with the following drugs: loperamide, cholestyramine, budesonide, methotrexate and adalimumab. Due to the intractable nature of the disease and because the patient was having up to 15 watery bowel movements per day, she underwent a temporary ileostomy. Colonic biopsies were analyzed for mucosal cytokine protein levels before and during fecal stream diversion and after intestinal continuity was restored. Mucosal protein levels of interleukin (IL)-1β, IL-2, IL-6, IL-12, IL-17 A, IL-23, TNF, IFN-γ, IL-4, IL-5, IL-10 and IL-13 were all higher during active disease and decreased to non-detectable or considerably lower levels during fecal stream diversion. One month after the restoration of bowel continuity, when the patient experienced a relapse of symptoms, IL-2, IL-23 and IL-21 levels were again increased. Our results indicate that fecal stream diversion in this patient suppressed the levels of all cytokines analyzed in colonic biopsies. With the recurrence of clinical symptoms and histological changes after bowel reconstruction, the levels of primarily proinflammatory cytokines increased. Our findings support the hypothesis that a luminal factor triggers the inflammation observed in collagenous colitis.
authors.affiliation: Niki Daferera, Magnus Ström, Andreas Münch, Division of Gastroenterology and Hepatology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, 58185 Linköping, Sweden.
authors.forename: Niki
authors.initials: N
authors.lastname: Daferera
authors.affiliation: Niki Daferera, Magnus Ström, Andreas Münch, Division of Gastroenterology and Hepatology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, 58185 Linköping, Sweden.
authors.forename: Ashok Kumar
authors.initials: AK
authors.lastname: Kumawat
authors.affiliation: Niki Daferera, Magnus Ström, Andreas Münch, Division of Gastroenterology and Hepatology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, 58185 Linköping, Sweden.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Hultgren-Hörnquist
authors.affiliation: Niki Daferera, Magnus Ström, Andreas Münch, Division of Gastroenterology and Hepatology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, 58185 Linköping, Sweden.
authors.forename: Simone
authors.initials: S
authors.lastname: Ignatova
authors.affiliation: Niki Daferera, Magnus Ström, Andreas Münch, Division of Gastroenterology and Hepatology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, 58185 Linköping, Sweden.
authors.forename: Magnus
authors.initials: M
authors.lastname: Ström
authors.affiliation: Niki Daferera, Magnus Ström, Andreas Münch, Division of Gastroenterology and Hepatology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, 58185 Linköping, Sweden.
authors.forename: Andreas
authors.initials: A
authors.lastname: Münch
mesh_terms: D015415:Biomarkers / Q000378:metabolism; D001706:Biopsy; D046729:Colitis, Collagenous / Q000175:diagnosis / Q000276:immunology / Q000378:metabolism / Q000601:surgery*; D003106:Colon / Q000276:immunology / Q000378:metabolism*; D016207:Cytokines / Q000378:metabolism*; D005260:Female; D006801:Humans; D007081:Ileostomy; D018836:Inflammation Mediators / Q000378:metabolism*; D007413:Intestinal Mucosa / Q000276:immunology / Q000378:metabolism*; D008875:Middle Aged; D012008:Recurrence; D012074:Remission Induction; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D016207:Cytokines; D018836:Inflammation Mediators
keywords: Collagenous colitis; Fecal stream diversion; Luminex; Microscopic colitis; Mucosal cytokines