Digestive Diseases and Sciences

, Volume 40, Issue 6, pp 1400–1404 | Cite as

Collagenous colitis

A treatable disease with an elusive diagnosis
  • Ronnie R. Pimentel
  • Edgar Achkar
  • Rudolph Bedford
Intestinal Disorders, Inflammatory Bowel Disease, Immunology, And Microbiology


Collagenous colitis is associated with normal endoscopy examination and peculiar histopathological changes. The natural history and optimal treatment are not well defined. Our objectives were to analyze the symptomatology of collagenous colitis, determine the natural history, and response to treatment. All patients with collagenous colitis from 1978 to 1992 were studied. Demographic data, symptomatology, associated conditions, colonoscopic findings, and pathology specimens were reviewed. Clinical improvement was classified as none, partial, or complete. Nineteen patients were identified, mainly white females over age 50. Mean follow-up was 22.6 months. Symptom duration was 37 months (range 4 months to 15 years). Symptoms were intermittent diarrhea (19), with a predominant nocturnal component (13); abdominal pain (15); and mild weight loss and incontinence (8). Colonoscopy was normal in 12 patients. Segmental mucosal edema and loss of vasculature pattern were present in seven. Antiperistaltic agents were used in 17 patients with no improvement (15), partial resolution (1), and complete resolution (1). Eight nonresponders received sulfasalazine. Responses were none (6) or complete (2). Ten patients received steroids (10–20 mg/day). One failed to respond. Nine initially responded completely but two relapsed. Seven patients who did not respond to any type of treatment improved eventually, two partially and five completely. These patients were younger (54.3 vs 68.3 years,P=0.04) and symptom duration was shorter (25.4 vs 44.5 months,P=0.38) than the rest of the patients. It is concluded that (1) nonspecific endoscopic abnormalities can be encountered in collagenous colitis in 40% of the cases; (2) low-dose steroids are the most effective treatment; (3) antiperistaltic agents and sulfasalazine are usually ineffective as primary therapy; and (4) collagenous colitis is a chronic, mild intermittent, and self-limited disease that, in some patients, can subside without treatment.

Key words

collagenous colitis diagnosis treatment 


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  1. 1.
    Lindstrom CG: Collagenous colitis with watery diarrhea: A new entity? Pathol Eur 11:87–89, 1976PubMedGoogle Scholar
  2. 2.
    Jessurum J, Yardley JH, Giardello FM, Hamilton SR, Bayless TM: Chronic colitis with thickening of the subepithelial collagen layer: Histologic findings in 15 patients. Hum Pathol 18:839–848, 1987PubMedGoogle Scholar
  3. 3.
    Giardello FM, Bayless TM, Jessurum J, Hamilton SR, Yardley JM: Collagenous colitis: Physiologic and histopathological studies in 7 patients. Ann Intern Med 106:46–49, 1987PubMedGoogle Scholar
  4. 4.
    Wang KK, Perrault J, Carpenter HA, Schroeder KW, Tremaine WJ: Collagenous colitis: A clinicopathological correlation. Mayo Clin Proc 62:665–671, 1987PubMedGoogle Scholar
  5. 5.
    Sylwestrowicz T, Kelly JK, Hwang WS, Shaffer EA: Collagenous colitis and microscopic colitis: The watery diarrheacolitis syndrome. Am J Gastroenterol 84:763–768, 1989PubMedGoogle Scholar
  6. 6.
    Lee E, Schiller LR, Venderel D, Santa Ana CA, Fordtran JS: Subepithelial collagen table thickness in the colon specimens from patients with microscopic colitis and collagenous colitis. Gastroenterology 103:1790–1796, 1992PubMedGoogle Scholar
  7. 7.
    Gledhill A, Cole FM: Significance of basement membrane thickening in the human colon. Gut 25:1085–1088, 1984PubMedGoogle Scholar
  8. 8.
    Chandratre S, Bramble MG, Cooke WM, Jones RA: Simultaneous occurrence of collagenous colitis and Crohn's disease. Digestion 36:55–60, 1987PubMedGoogle Scholar
  9. 9.
    Giardiello FM, Hansen FC, Lozenbi AJ, Hellman DB, Milligan FD, Bayless TM, Yardley JH: Collagenous colitis in the setting of non steroidal antiflammatory drugs and antibiotics. Dig Dis Sci 35:257–260, 1990PubMedGoogle Scholar
  10. 10.
    Roubenoff R, Ratain J, Giardello F, Hochberg M, Bias W, Lazenby A, Yardley JH: Collagenous colitis, enteropathic arthritis and autoimmune diseases: Results of a patient survey. J Rheumatol 16:1229–1232, 1989PubMedGoogle Scholar
  11. 11.
    Farah DA, Mills PR, Lee FD, McLay A, Russell RI: Collagenous colitis: Possible response to sulfasalazine and local steroid therapy. Gastroenterology 88:792–797, 1985PubMedGoogle Scholar
  12. 12.
    Weidner N, Smith J, Patteee B: Sulfazalazine in the treatment of collagenous colitis. Case report and review of the literature. Am J Med 77:162–166, 1984PubMedGoogle Scholar
  13. 13.
    Esselinckx W, Brennard R, Colin JF, Melange M: Juvenile scleroderma and collagenous colitis: The first case. J Rheumatol 16:834–836, 1989PubMedGoogle Scholar
  14. 14.
    Gremse DA, Boudreaux CW, Manci EA: Collagenous colitis in children. Gastroenterology 104:906–909, 1993PubMedGoogle Scholar
  15. 15.
    Busutill A: Collagenous colitis in a child. Am J Dis Child 143:998–1000, 1989Google Scholar
  16. 16.
    Rask-Madsen J, Grove O, Hansen MGJ, Bukhave K, Scient C, Henrik-Nielson R: Colonic transport of water and electrolytes in a patient with secretory diarrhea due to collagenous colitis. Dig Dis Sci 28:1141–1146, 1983PubMedGoogle Scholar
  17. 17.
    Stark ME, Batts KP, Alexander GL: Protein losing enteropathy with collagenous colitis. Am J Gastroenterol 87:780–783, 1992PubMedGoogle Scholar
  18. 18.
    Lawson JM, Wolosin J, Mottet D, Brower RA: Collagenous colitis: An association with fecal leukocytes. J Clin Gastroenterol 10:672–675, 1988PubMedGoogle Scholar
  19. 19.
    Carpenter HA, Tremaine WJ, Batts KP, Czaja AJ: Sequential histologic evaluations in collagenous colitis: Correlations with disease behavior and sampling strategy. Dig Dis Sci 37:1903–1909, 1992PubMedGoogle Scholar
  20. 20.
    Sloth H, Bisgaard C, Grove A: Collagenous colitis: A prospective trial of prednisolone in six patients. J Intern Med 229:443–446, 1991PubMedGoogle Scholar
  21. 21.
    Palmer KR, Berry H, Wheeler PJ, Williams CB, Fairclough P, Morson BC, Silk DB: Collagenous colitis a relapsing and remitting disease. Gut 27:578–580, 1986PubMedGoogle Scholar

Copyright information

© Plenum Publishing Corporation 1995

Authors and Affiliations

  • Ronnie R. Pimentel
    • 1
  • Edgar Achkar
    • 1
  • Rudolph Bedford
    • 1
  1. 1.From the Department of GastroenterologyCleveland Clinic FoundationCleveland

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