Clinical Management of Lymphocytic Colitis With Serum-Derived Bovine Immunoglobulin/Protein Isolate (SBI)

Abstract

The pathophysiology of lymphocytic colitis (LC) is not completely understood. Current hypotheses implicate abnormal mucosal immune response to luminal antigens in combination with genetic predisposition. Five cases detail the outcomes of adding serum-derived bovine immunoglobulin/protein isolate (SBI) for the nutritional management of these unresponsive LC patients. SBI's unique mechanism includes binding microbial components and maintaining normal GI immune balance which makes it a candidate therapy in LC patients. Five patients were administered SBI for LC. All patients were female with an average age of 71±7.1 yrs. Patient 1 was admitted to the hospital with 20-24 bowel movements (BM) per day with cramps and urgency. Biopsies from a colonoscopy were consistent with LC. She was placed on mesalamine and methylprednisolone without any change. Patient 2 had tried and failed multiple tapering doses of budesonide for 2 yrs with continual multiple, loose stools per day. Patient 3 had been diagnosed with IBS-D for 15 yrs and failed all over-the-counter options. Recent biopsies, however, indicated LC. Patient 4 had a poor response to steroids and psyllium fiber for 2.5 yrs with a history of fecal incontinence (FI). Patient 5 had a diagnosis of LC for 1.5 yrs; she had a history of anal fistula repairs with multiple loose BM in the a.m. accompanied by intermittent episodes of FI. She had no response to mesalamine, loperamide or antibiotics. Incorporating SBI dramatically improved symptoms for all patients. Patient 1 was discharged from the hospital on SBI 5g QD and continued on 1.2g mesalamine having 4 formed BM without cramping, urgency or bleeding. However, if the patient missed more than two days of SBI, she quickly experienced 10-14 watery BM daily. Patient 2 first began SBI 5g BID with budesonide, but was able to discontinue the steroid while maintaining normal BM on SBi monotherapy. Patient 3 was placed on budesonide and SBI 5g QD normal BM within a week. Patient 4 began SBI 5g QD in addition to psyllium fiber and at follow-up reported formed stools with no episodes of FI. After initiating SBI 5g QD, Patient 5 reported 1-2 formed BM without FI. All patients are currently maintained on SBI in combination with the therapies indicated above for more than 6 months. No side effects have been experienced on SBI during that time. The exact manner in which SBI manages LC is not known. The outcomes of these cases, however, suggest that LC patients may benefit from the distinct nutritional proteins in SBI for management of their conditions. Larger, well-controlled studies in patients with LC and/or FI should be performed to corroborate these findings.