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Abstract

We thank Dr Koulaouzidis for sharing the interesting images and the hypothesized mechanism underlying these endoscopic lesions. Other reports, also showing mucosal scarring in collagenous colitis, have been recently published.1Hashimoto Y. Endo Y. Kuroki Y. et al.Collagenous colitis with unique colonoscopic findings.Endoscopy. 2008; 40 (E162)Google Scholar, 2Umeno J. Matsumoto T. Nakamura S. et al.Linear mucosal defect may be characteristic of lansoprazole-associated collagenous colitis.Gastrointest Endosc. 2008; 67: 1185-1191Abstract Full Text Full Text PDF PubMed Scopus (47) Google Scholar Allende et al3Allende D.S. Taylor S.L. Bronner M.P. Colonic perforation as a complication of collagenous colitis in a series of 12 patients.Am J Gastroenterol. 2008; 103: 2598-2604Crossref PubMed Scopus (46) Google Scholar also report on colectomy specimens from collagenous colitis patients with ragged mucosal defect and induration of the wall, suggestive of scarring.These mucosal scars are insufflation-related or spontaneous mucosal tears (secondary to mucosal stretching during normal peristalsis and defecation) that ultimately healed. The most striking argument in favor of this sequence comes from a postcolonoscopy scar diagnosed by Wickbom et al4Wickbom A. Lindqvist M. Bohr J. et al.Colonic mucosal tears in collagenous colitis.Scand J Gastroenterol. 2006; 41: 726-729Crossref PubMed Scopus (61) Google Scholar 7 days after mucosal tears were seen. As we emphasize in our case report,5Couto G. Bispo M. Barreiro P. et al.Unique endoscopy findings in collagenous colitis.Gastrointest Endosc. 2009; 69: 1186-1188Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar we do agree with the proposed mechanism of colonic mucosal tearing of Dr Koulaouzidis, in line with the hypothesis of Cruz-Correa et al6Cruz-Correa M. Milligan F. Giardiello F.M. et al.Collagenous colitis with mucosal tears on endoscopic insufflation: a unique presentation.Gut. 2002; 51: 600Crossref PubMed Scopus (59) Google Scholar and Sherman et al.7Sherman A. Ackert J.J. Rajapaksa R. et al.Fractured colon: an endoscopically distinctive lesion associated with colonic perforation following colonoscopy in patients with collagenous colitis.J Clin Gastroenterol. 2004; 38: 341-345Crossref PubMed Scopus (63) Google Scholar We thank Dr Koulaouzidis for sharing the interesting images and the hypothesized mechanism underlying these endoscopic lesions. Other reports, also showing mucosal scarring in collagenous colitis, have been recently published.1Hashimoto Y. Endo Y. Kuroki Y. et al.Collagenous colitis with unique colonoscopic findings.Endoscopy. 2008; 40 (E162)Google Scholar, 2Umeno J. Matsumoto T. Nakamura S. et al.Linear mucosal defect may be characteristic of lansoprazole-associated collagenous colitis.Gastrointest Endosc. 2008; 67: 1185-1191Abstract Full Text Full Text PDF PubMed Scopus (47) Google Scholar Allende et al3Allende D.S. Taylor S.L. Bronner M.P. Colonic perforation as a complication of collagenous colitis in a series of 12 patients.Am J Gastroenterol. 2008; 103: 2598-2604Crossref PubMed Scopus (46) Google Scholar also report on colectomy specimens from collagenous colitis patients with ragged mucosal defect and induration of the wall, suggestive of scarring. These mucosal scars are insufflation-related or spontaneous mucosal tears (secondary to mucosal stretching during normal peristalsis and defecation) that ultimately healed. The most striking argument in favor of this sequence comes from a postcolonoscopy scar diagnosed by Wickbom et al4Wickbom A. Lindqvist M. Bohr J. et al.Colonic mucosal tears in collagenous colitis.Scand J Gastroenterol. 2006; 41: 726-729Crossref PubMed Scopus (61) Google Scholar 7 days after mucosal tears were seen. As we emphasize in our case report,5Couto G. Bispo M. Barreiro P. et al.Unique endoscopy findings in collagenous colitis.Gastrointest Endosc. 2009; 69: 1186-1188Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar we do agree with the proposed mechanism of colonic mucosal tearing of Dr Koulaouzidis, in line with the hypothesis of Cruz-Correa et al6Cruz-Correa M. Milligan F. Giardiello F.M. et al.Collagenous colitis with mucosal tears on endoscopic insufflation: a unique presentation.Gut. 2002; 51: 600Crossref PubMed Scopus (59) Google Scholar and Sherman et al.7Sherman A. Ackert J.J. Rajapaksa R. et al.Fractured colon: an endoscopically distinctive lesion associated with colonic perforation following colonoscopy in patients with collagenous colitis.J Clin Gastroenterol. 2004; 38: 341-345Crossref PubMed Scopus (63) Google Scholar Mucosal scars in collagenous colitisGastrointestinal EndoscopyVol. 71Issue 1PreviewTo the Editor: Full-Text PDF