Active Microscopic Colitis Research Articles

Active microscopic colitis precipitated by fluoxetine.

Microscopic colitis is a form of chronic and recurrent inflammatory bowel disease characterized by non-bloody, watery diarrhea, macroscopically normal colonic mucosa, and characteristic histopathological findings. Some drugs have been described as triggers of colonic inflammation in predisposed individuals, while others may exacerbate microscopic colitis that evolves on its own. We present the case of a patient diagnosed with active microscopic colitis in relation to taking fluoxetine at high doses.

Colonic bacterial diversity and dysbiosis in active microscopic colitis as compared to chronic diarrhoea and healthy controls: effect of polyethylene glycol after bowel lavage for colonoscopy

BackgroundMost microbiota studies in microscopic colitis patients are performed after diagnostic colonoscopy without considering the potential effect of colonic lavage. Patients may achieve clinical remission after colonoscopy and it is unknown whether lavage-induced changes play a role.AimTo assess the effect of polyethylene glycol (PEG) colonic lavage on clinical remission rate, microbial diversity, microbial dysbiosis index and specific microbial changes in patients with active microscopic colitis as compared to other diarrhoeal diseases and healthy controls.MethodsFifty-five consecutive patients presenting chronic watery diarrhoea and 12 healthy controls were included. Faecal samples were collected three days before and 30 days after PEG in patients and controls for microbiome analysis.ResultsClinical remission was observed in 53% of microscopic colitis patients, and in 32% of non-microscopic colitis patients (p = 0.16). Considering patients with persisting diarrhoea after colonoscopy, 71% of non-microscopic colitis patients had bile acid diarrhoea. Baseline Shannon Index was lower in diarrhoea groups than in healthy controls (p = 0.0025); there were no differences between microscopic colitis, bile-acid diarrhoea and functional diarrhoea. The microbial dysbiosis index was significantly higher in microscopic colitis than in bile acid diarrhoea plus functional diarrhoea (p = 0.0095), but no bacterial species showed a significantly different relative abundance among the diarrheal groups.ConclusionsDysbiosis is a feature in active microscopic colitis, but loss of microbial diversity was similar in all diarrheal groups, suggesting that faecal microbial changes are not due to microscopic colitis itself but associated with stool form. A considerable number of microscopic colitis patients achieved clinical remission after colonoscopy, but we were unable to demonstrate related PEG-induced changes in faecal microbiome.

S0233 The Role of Breath Testing in Microscopic Colitis

INTRODUCTION: Microscopic colitis (MC) is a diarrheal illness difficult to differentiate from other gastrointestinal disorders. Historical cues and understanding of disease prevalence are critical to the evaluation of MC patients experiencing continued symptoms despite adequate treatment or histologic improvement. This study examines the prevalence of concomitant small intestine bacterial overgrowth (SIBO) and carbohydrate malabsorption in a MC population. METHODS: Records were reviewed from 6/2015 to 6/2020 at a single-center private gastroenterology practice. Patients with MC were identified by ICD10 codes and grouped into either collagenous (CC) (K52.831), lymphocytic (LC) (K52.832), or other microscopic colitis (K52.839). Patient demographics, surgical history, disease activity, medications, fecal calprotectin, date of initial diagnosis, and breath testing results were recorded in a HIPAA compliant dataset. Data were analyzed using chi-squared, Fisher’s exact, Pearson correlation, and T testing where indicated. RESULTS: 223 MC patients were reviewed with 67 included based on the presence of SIBO hydrogen (H2) breath testing: 50 with LC, 10 with CC, 4 with CC and MC, and 3 indeterminate. The average age at MC diagnosis was 64.9 ± 14.6, with a higher prevalence of females (73.1%) and whites (78.9%). SIBO positive rates were 19/54 (35.2%) in the LC group and 5/14 (35.7%) in the CC group (P = 0.97) (Figure 1). There was no difference in SIBO positivity between age groups (< 70 vs > 70, P = 0.82), genders (P = 0.33), or ethnicities (P = 0.35). SIBO rates in patients with active MC (defined as > 3 watery bowel movements daily) did not differ from patients in remission (30.6% vs 28.6%, P = 0.89). The average fecal calprotectin (FC) in the SIBO positive group was 84.4 mg/mg, compared to 262.6 mg/mg in the SIBO negative group (P = 0.31) (Figure 2). Concurrent carbohydrate malabsorption was observed in 47.4% of SIBO positive patients, compared to 61.1% in the SIBO negative group (P = 0.33) (Figure 3). CONCLUSION: This retrospective cross sectional study illustrates rates of SIBO positivity in the MC population are similar to symptomatic patients in the general population (Figure 1). There was no difference in positive rates between the LC and CC groups, limited by a small CC sample size. Furthermore, carbohydrate malabsorption was frequently superimposed on the MC diagnosis, highlighting the need to consider H2 breath testing for both SIBO and carbohydrate malabsorption in symptomatic MC patients who are unresponsive to therapy.Figure 1.: Similar rates of SIBO positivity were observed between collagenous and lymphocytic colitis (35.2% vs 35.7%, P = 0.97). Rates of bacterial overgrowth in the general population are estimated 2-22%, though our study’s rates of positive SIBO breath testing correlate with rates from a Vizuete et al, which found SIBO positivity in 32.9% of patients with “flatulence, eructation, and gas pain”. No statistical difference in SIBO positivity was seen between age groups (39.1% (< 70) vs 36.4% (> 70), P = 0.82), genders (27.8% (M) vs 40.8% (F), P = 0.33), or ethnicities (43.3% (white) vs 25.0% (non-white), P = 0.35).Figure 2.: There was no difference in SIBO positive rates between patients with active microscopic colitis (described as at least 3 bowel movements per day) versus patients in remission (30.6% vs 28.6%, P = 0.89). When comparing SIBO positive to negative patients, there was no difference in the percentage of patients on steroid therapy at the time of breath testing (12.0 vs 14.3%, P = 0.79).Figure 3.: Carbohydrate malabsorption was frequently observed in all tested patients (56.4%). Positive rates of fructose/lactose/sucrose intolerance were observed more frequently in the SIBO negative group (47.4% vs 61.1%, P = 0.33). There was no observed difference between collagenous colitis patients (CC) and lymphocytic colitis patients (LC) with regard to rates of individual carbohydrate malabsorption.

Efficacy and Safety of Oral Rifaximin in Patients With Active Microscopic Colitis

Efficacy and Safety of Oral Rifaximin in Patients With Active Microscopic Colitis

Pentoxifylline Use in Microscopic Colitis: A Case Series

Introduction: Microscopic colitis is a chronic inflammatory disease of the colon and a common cause of diarrhea. Pentoxifylline is a xanthine derivative with anti- TNF-alpha properties which is prescribed for intermittent claudication and other disorders. Our aim was to evaluate the outcomes of patients with active microscopic colitis treated with pentoxifylline. Methods: Patients seen between January 1, 1997 and November 30, 2016 with a histologic diagnosis of microscopic colitis were identified. Patients treated with pentoxifylline were selected and clinical outcomes recorded. Results: Nine microscopic colitis patients (8 collagenous colitis and 1 lymphocytic colitis) with a median disease duration of 64.8 months (range, 60-109) were included. The indications for treatment were budesonide-refractoriness in 7 patients, budesonide dependence in 1 patient, and budesonide intolerance in 1 patient. The median age was 56.9 years (range, 51.6-60.2) and 8 were female (89%). Pentoxifylline was used for a median of 3 months (range, 2.5-8.3). Complete and partial response occurred in 1 patient (11%) and 3 patients (33%), respectively. The patient who achieved complete remission was treated with pentoxifylline due to budesonide-intolerance and completed 43 months of successful maintenance therapy. There were no adverse effects reported. Conclusion: The majority of budesonide experienced patients with active microscopic colitis did not respond to pentoxifylline. However, it was well tolerated with one patient achieving sustained long-term remission and one-third of the cohort having a partial response. Larger controlled studies are required to evaluate the efficacy of pentoxifylline in microscopic colitis. In particular, patients who are not budesonide refractory may be more likely to respond.

Sa1956 - Immunosuppressant Use in Chronic, Active Microscopic Colitis in Clinical Practice

Sa1956 - Immunosuppressant Use in Chronic, Active Microscopic Colitis in Clinical Practice

VSL#3 induces and maintains short-term clinical response in patients with active microscopic colitis: a two-phase randomised clinical trial

BackgroundThe probiotic mixture VSL#3 has proven efficacious in inflammatory bowel diseases and irritable bowel syndrome; however, its efficacy in microscopic colitis (MC) is being investigated.ObjectiveTo evaluate the safety and efficacy...

Study the Efficacy of Budesonide Enema in Treating Collagenous Microscopic Colitis: An Egyptian Trial

Chronic diarrhea can have a substantial impact on the patient’s quality of life and overall health. Microscopic colitis (MC) is an inflammatory bowel disease, which is characterized by chronic watery diarrhea. Many drugs, including steroids, had emerged to treat MC. Our aim was testing the efficacy of Budesonide enema in improvement of patients with collagenous microscopic colitis both clinically and histo-pathologiclly. 22 patients with active microscopic colitis were enrolled in the present study, 15 women, and 7 men, with mean age of 60.9±8.5 years. Mean duration of symptoms was 2.6±0.8 years. Patients were given Budesonide enema 2mg/100ml twice daily for 2 weeks then, once daily for 4 weeks. They were evaluated both clinically and histopathologically after 6 weeks.18 patients (81.8%) showed high statistically significant decrease in the thickness of collage layer, and degree of inflammation. The patients’ frequency of stool decreased from 7.6±1.0 to 2.7±1.6 motions/day (p<0.001), and also consistency of stool improved (p<0.001).We concluded that Budesonide enema in a dose of 2 mg/100ml was well tolerated and effective in induction of remission in active collagenous colitis. Effects on both clinical symptoms and inflammatory infiltrate were seen. Recurrence rate after stopping treatment is moderate. Non-responders may need prolonged duration of treatment or omitting the drugs that may be responsible for colonic inflammation.

Azathioprine and mercaptopurine in the management of patients with chronic, active microscopic colitis

Microscopic colitis (MC) is a common chronic diarrhoeal disease, and remission can be induced with budesonide. However, diarrhoea relapses frequently when budesonide is tapered and a few patients become budesonide intolerant. To examine retrospectively the effect of azathioprine (AZA) and mercaptopurine (MP) in patients with chronic, active MC. Data on all MC patients who received AZA or MP in the years 1997-2011 at three centres representing three countries were pooled for analysis. The indications for thiopurine therapy were frequent relapses after short-term treatment (N = 26), budesonide dependency on 6 mg (N = 15) and budesonide intolerance (N = 5). The response to thiopurine treatment was defined as clinical remission, intolerance or nonresponse. Forty-six MC patients (32 CC and 14 LC), 32 female; median age 59 years (range: 36-83) with a median disease duration of 3 years (range: 0.5-18) were included. Thirteen patients (28%) achieved long-term clinical remission on AZA therapy. AZA failed in 31 patients (67%) due to intolerance and in 2 patients (4%) because of nonresponse. Thirteen of 31 AZA-intolerant patients were switched to MP and 6 patients (46%) obtained clinical remission. Thus, the overall response rate to thiopurines was 19/46 (41%). The main side effects were nausea/vomiting and abnormally elevated liver enzymes. In this retrospective case series, the majority of chronic, active MC patients were intolerant to AZA leading to cessation of treatment. However, further studies are needed to explore the efficacy, acceptance, tolerance and safety of MP in patients with chronic, active MC refractory to budesonide.

A randomized trial of a probiotic preparation VSL#3 for inducing and maintaining clinical response in patients with active microscopic colitis

A randomized trial of a probiotic preparation VSL#3 for inducing and maintaining clinical response in patients with active microscopic colitis

A randomized trial of a probiotic preparation VSL#3 for inducing and maintaining clinical response in patients with active microscopic colitis

A randomized trial of a probiotic preparation VSL#3 for inducing and maintaining clinical response in patients with active microscopic colitis

W1773 A Randomized Trial Evaluating Probiotic Preparation Vsl#3 Versus Oral mesalamine in Patients with Active Microscopic Colitis

W1773 A Randomized Trial Evaluating Probiotic Preparation Vsl#3 Versus Oral mesalamine in Patients with Active Microscopic Colitis