Abstract

Objectives Microscopic colitis (MC) is characterized by chronic diarrhea, normal colonoscopy findings, and mucosal inflammation in colonic biopsies and can be classified as collagenous colitis (CC) or lymphocytic colitis (LC). However, the pathogenesis of MC is largely unknown. In this study, we aimed to study mast cell counts and activation in MC. Methods We investigated 64 biopsy samples from the surgical pathology database of Indiana University Health, which met the diagnostic criteria for CC or LC along with 20 control samples collected from 2014 to 2015. The specimens were used for the quantification of mast cells by examining the presence of intracellular and extracellular tryptase by immunohistochemistry. Results In the lamina propria, the mast cell count was higher in both CC and LC groups than the control (mean highest count, 39/high-power field (HPF) vs. 30/HPF vs. 23/HPF; P < 0.01). Extracellular tryptase was present in 10% of control subjects as compared to 41% of CC (P < 0.01). Extracellular tryptase was present in 10% of control subjects as compared to 41% of CC (P < 0.01). Extracellular tryptase was present in 10% of control subjects as compared to 41% of CC (Conclusions The increased mast cell count and degranulation are identified in MC, suggesting that mast cell activation might be involved in the pathogenesis of MC.

Highlights

  • Microscopic colitis (MC) is an umbrella term for a disorder characterized by chronic diarrhea, normal colonoscopy appearance, and mucosal inflammation in colonic biopsies [1]

  • A total of 64 biopsy cases in the surgical pathology database of Indiana University Health from 2014 to 2015 that met the diagnostic criteria of collagenous colitis (CC) or lymphocytic colitis (LC) were analyzed in this study, along with samples from 20 healthy control subjects from the same time period

  • The 20 control subjects had an average age of 61 years and included 14 females (70%); the 29 CC patients had an average age of 68 years, with 26 females (90%); and the 35 LC patients had an average age of 69 years, with 24 females (68%) (Table 1)

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Summary

Introduction

Microscopic colitis (MC) is an umbrella term for a disorder characterized by chronic diarrhea, normal colonoscopy appearance, and mucosal inflammation in colonic biopsies [1]. The two best-defined subtypes of MC are collagenous colitis (CC) and lymphocytic colitis (LC) The latter is histologically defined by intraepithelial lymphocytosis, mucosal surface damage and mucin loss, and expanded lamina propria (LP) with lymphoplasmacytic infiltration [8, 9]. The key histological feature of CC is the deposition of an abnormally thickened collagen layer underneath the surface epithelium [10, 11]. Clinical presentation of both subtypes includes chronic watery diarrhea, abdominal pain, and weight loss [12]. The relapse rate after discontinuation of budesonide is high, and development of corticosteroid dependency and adverse side effects has been observed with long-term treatment [15]

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