Collagenous Colitis Preceding UC

[Joefnh]

Here is an interesting article published in the Canadian Journal of Gastroenterology. The study looks at several cases of CC that have segued into UC. Two of the interesting points made in this article are that there is a "intimate relationship between collagenous colitis and celiac disease" and second that CC needs be treated early and aggressively to avoid this transition

In some individuals, the disease may also involve the stomach and the small intestine (2,3). Finally, there is an intimate relationship between collagenous colitis and celiac disease (4,5).

The present report documents yet another serious colonic complication of collagenous colitis, namely, the development of severe and extensive ulcerative colitis.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2657714/


Overall some more than interesting notes about CC

--Joe

[Gloria]

That's pretty scary, Joe. We've all assumed that CC has a benign course. I wonder if their conclusion also applies to LC?

Gloria

[Joefnh]

Gloria over the past months I have had several people ask me which is worses Crohns or CC. When you have both it can be hard to differentiate between them, but over time I have come to the conclusion that while the symptoms are quite similar, I believe it is much harder to live with MC as compared to Crohns. Finally as mentioned in the paper the researchers feel that CC is intimately related to Celiac disease, and from the experiences on this board, I would in principle have to agree. Overall MC is anything but benign

The reason I say this is that the MC with all of the dietary restrictions and wide range of symptoms and systemic involvement from food intolerances, makes it a lot harder to deal with. The only reason Crohns is considered 'worse', is due to the cumulative damage that can occur if the Crohns is not managed correctly with meds and to some degree diet.

It would not surprise me a bit to find that MC really is part of the disease mechanism in a number of Crohns and Ulcerative Colitis cases as this paper suggests.

--Joe

[MBombardier]

Just when you thought it was safe to go back in the water... Wonder how the elimination of gluten effects or would have effected this process?

[klhale]

That's interesting and may explain when I visited the Doc and she made me take the Promethius Laboratories bloodtest, I tested positive for Ulcerative colitis and negative for Celiac. However, they do not have MC as an option to check on the lab results form. So maybe the blood markers are the same. I don't know.

She wanted to do a colonoscopy to see if I have UC now, but I skipped that, and have stayed on Entocort. I am doing pretty good now ( one entocort a day), but had to completely change my diet again.

Karen

[natythingycolbery]

I'm sure I have been told before it can turn into UC.... I think its when i heard about LC and CC maybe being the same types of MC at different stages.

I dunno, i'm half asleep!

But it seems interesting and I shall have a proper nosey when i am awake in the morning.

[grannyh]

I had to do the blood work with prometheus labs as well.. was negative for celiac and ulcerative colitis and crohns. So far my GI doc maintains that CC doesn't turn into anything else as long as it is treated.. guess time will tell for me.
grannyh

[tex]

Hmmmmmm. Yes, that certainly is an interesting article. Before everyone panics, though, consider this:

Call me a skeptic, but I get the impression that those authors are maybe just a tad too sensational with their report. I've seen the prior few case studies that they mention, where CC supposedly segued into UC, but in most of those cases, as these authors point out, farther down in their report, inadequate followup precludes solid substantiation that CC actually progressed into UC. Most likely, the CC had nothing to do with the fact that those few patients developed UC, it was mere coincidence. CC does not make anyone immune to developing any other IBD - we all have the same chance of developing it as anyone in the general population.

This case study is claimed to be thorough enough to avoid those prior problems, but the authors make so many radical claims that run contrary to general knowledge about both CC and UC, that it is difficult to take them seriously. They pull out all the stops to make CC look like one of the most fearsome diseases to ever come down the pike. Consider the facts of the case:

Note that this was a case study of a single patient, and note especially how drastically many of the claims of the authors deviate from conventional thinking about the diseases involved. For example, they lead into a discussion of their startling observations about their patient, by pointing out all these sensational claims, which run contrary to typical CC behavior:

Other complications include spontaneous peritonitis with free perforation of the colonic wall (9), submucosal dissection (10) and colonic ‘fracturing’, apparently during endoscopic instrumentation (11). Colon carcinoma may also complicate the clinical course of collagenous colitis (12,13), while lymphoma and carcinoid tumours have also been noted in some case studies (14–16). Recently, a paraneoplastic form of collagenous inflammatory disease involving the small intestine and the colon completely resolved following resection of an invasive colon carcinoma (17). The present report documents yet another serious colonic complication of collagenous colitis, namely, the development of severe and extensive ulcerative colitis.

The red emphasis is mine, of course. What's this "paraneoplastic form of collagenous inflammatory disease involving the small intestine and the colon"? That doesn't sound like CC. Furthermore, an invasive colon carcinoma, and CC, are generally considered to be either mutually exclusive or at least unrelated.

Over the next eight months, her symptoms became more severe despite treatment with 5-ASA, and the addition of oral prednisone (40 mg daily) and azathioprine (100 mg daily).

IOW, the patient didn't respond to mesalazine, prednisone, nor Imuran. Really? This is obviously not a typical patient. Right? They go to extra pains to point out that not only did all the thickened collagen bands in the lamina propria completely disappear, but lymphocytic infiltration totally disappeared, as well. Remember how it took Polly approximately 10 years on the diet to get normalization of her epithelial histology? Remember how no one else on this board has been able to have a follow up colonoscopy that produced biopsy samples with normal histology? Return to normal histology does not happen within a matter of a few months - it takes years. I suggest that when the patient in this case study developed UC, the disease was so aggressive, that most evidence of CC was obliterated, and any that might have remained, was simply overlooked by the researchers, in their dedicated attempt to produce a "sensational" case report. Even if what they report is absolutely true, obviously the patient involved was no ordinary CC patient - this would have had to have been an extremely unique case, since so many typical characteristics of CC and UC "went out the window", as the story unfolded.

While associations between collagenous colitis and other inflammatory bowel disorders (eg, Crohn’s disease) have been reported in the same patient (22,23) or family (24), this could occur due to chance alone.

It certainly could. Or, maybe that report is as honest and as accurate as the day is long. Just remember, though, that the conclusions of most research reports are wrong. And that's a fact. The trick is in figuring out which ones are valid, and which ones are not.

Also, as we all know, there are exceptions, (somewhere), to every rule.

Tex

[grannyh]

Let me just throw out something nuts...:) These doctors who do studies.. tend to do lots of follow up colonoscopies..which means these patients are getting lots of colon preps.. any chance these repeated colon preps are causing/triggering more problems?????
grannyh

[tex]

Very, very good point. Note how the patient almost immediately developed pancolitis - that kind of rapid progression is rather unusual, to say the least. Most UC is confined to the rectum, and is slow to progress, or it's confined to the rectum and the sigmoid colon, not the entire colon.

Tex

[grannyh]

Now that my GI doc has found all these MC cases that popped up AFTER scopes being done.. I really am leary of studies since the involve so many scopes for follow up for studies...

Studying MC isn't easy.. since the very tests needed for verification may be the very things that make studying them so difficult.

Probably why this forum is so important.. as we all muddle through... we may find that any doctor who wants to do lots of scopes is only out to do their own research while making us sicker.

We can learn so much from each other without scopes as long as we have no other problems that would require more scopes. Just my opinion.. as one who has said.. no more scopes for me:)
grannyh

[Joefnh]

Hi Tex, I did note the sensational tone for a research paper, but there were a few interesting notes to be taken form it. Up front the authors did draw a strong link to celiac disease - gluten intolerance?; I did not see them explore that thoroughly but the admission is interesting given the preponderance of gluten sensitivity among those with MC. Could the medical community community finally be seeing light as it were?

Other than that, this note we have been discussing lately of the colonoscopy preparation potentially causing latent MC to become more active is an interesting observation.

Happy New Year

--Joe

[tex]

Hi Joe,

I agree with you, and I certainly didn't mean to imply that the article was totally without merit - there were definitely some good observations in it.

Stress is such a potent problem for many/most of us, though, that I felt obligated to point out how extremely rare such a case actually is, lest someone here fall out of remission, because of worrying about something that is never going to happen to them, personally. It's easy to get carried away, and dwell on such morbid possibilities, but the odds are almost astronomical that it will never to happen to any of us, thank goodness.

This is another good reason to try to control one's symptoms as quickly as possible, also, because when inflammation is allowed to run amuck, all sorts of bad things can happen, somewhere down the line. I'm a good example of that - I have a lot of permanent health issues that were caused by not figuring out the problem early enough to enable me to begin treatment soon enough to reverse all the symptoms.

Happy New Year, Joe, and more than that - I wish you a most Healthy New Year.

Tex

[Joefnh]

Your not kidding Tex stress is the great multiplier...

I guess what caught my eye the most was the statement about MC's intimate link to celiac disease. I don't think I have seen a paper say that yet. But as we know all so well there are similarities when it comes to our not so good friend gluten.

Happy new year Tex

--Joe

[tex]

Joe,

There are a few citations floating around, but the connection seems to have been mostly ignored by most medical authorities.

http://www.ncbi.nlm.nih.gov/pubmed/19631283

Of course, I believe that the article that you cited was published in 2007, (if I remember correctly), but the association was known long before then, (though pretty much ignored by the mainstream medical community. Dr. Fine pointed it out over 10 years ago:

http://www.ncbi.nlm.nih.gov/pubmed/10950045

Then there are occasional observations such as this:

http://www.ncbi.nlm.nih.gov/pubmed/20575599

Incidentally, Joe, have you ever seen this discussion before, which points out that MC is about as common as UC and Crohn's?

http://www.crohnsforum.com/showthread.php?t=10000

Tex