Are collagenous and lymphocytic colitis different aspects of the same disease?

Objective. Collagenous colitis (CC) and lymphocytic colitis (LC) are two subtypes of microscopic colitis (MC). Even though they most often are described as different entities they share many clinical and histological features. The aim of this study was to investigate the occurrence of conversion between CC and LC in a larger cohort of patients. Materials and methods. All 664 patients in our Pathology register with a diagnosis of CC and LC were scrutinized and those where additional endoscopies had been carried out were included, and their biopsies were re-examined. Results. Sixty-five patients (55 women, 10 men, median age 58 years; range 29-86) fulfilled our criteria for inclusion. The primary diagnosis was CC in 47 patients (39 women, 8 men, median age 58 years; range 29-86) and LC in 18 patients (16 women, 2 men, median age 58 years; range 33-74). Conversion occurred in nine of the 65 patients (14%, all women, median age 59 years; range 41-72), three from CC to LC and six from LC to CC. Conclusion. This study has found that patients can show histological features consistent with both CC and LC over time. These patients could represent a subgroup with a true conversion between two separate entities. Alternatively, MC could be a spectral disease where the varying histological features are manifestations of the natural fluctuation. A third possibility could be that the histological changes reflect different manifestations during the disease course and consequently, the diagnostic criteria could be too vague

Collagenous colitis. Epidemiology, risk factors, clinical presentation and associated autoimmune disorders

Collagenous colitis (CC) affects middle-aged women and results in chronic watery non-bloody diarrhoea. The incidence of CC has increased but has never been determined in southern Sweden. During the period 2001-2010 the mean annual incidence was stable; 5.4/105 (median age 71 years). The female: male ratio was 2.8:1, lower than in previous reports. The association between smoking and classic IBD is well known while data on smoking in CC were lacking. Among 116 patients (92 women, median age 62 years) 37% were smokers compared to 17% of controls (p < 0.001). Smokers developed the disease at 42 years (median) compared to 56 years in non-smokers (p < 0.003). Collagenous colitis and LC are regarded as different entities but share many features. Out of 664 patients with CC or LC 65 patients hade been investigated more than once. Conversion occurred in nine (14%, all women, mean age 58 years), three from CC to LC and six from LC to CC. It remains to determine whether this is due to true conversion, spectral disease with varying histology or different histological manifestations over time – the diagnostic criteria could be too vague. Collagenous colitis is associated with autoimmune disorders. This relationship was studied in 116 CC patients (92 women, median age 62 years) and 32% had one or more autoimmune disorder [Coeliac disease (13%), autoimmune thyroid disease (10%), Sjögren´s syndrome (3%), diabetes mellitus (2%) and conditions in skin and joints (8%)]; a pattern of autoimmunity similar to that in classic IBD

Effekten av olika typer av fysisk aktivitet på psykisk ohälsa : Vad har forskningen kommit fram till mellan åren 2007-2017?

Bakgrund: Psykisk ohälsa är ett allvarligt folkhälsoproblem och en stor bidragande orsak till olika sjukdomar i dagens samhälle. Fysioterapi kan vara en effektiv behandlingsmetod vid psykisk ohälsa Syfte: Syftet med studien var att sammanställa en litteraturöversiktöver studier som undersökt fysiska aktivitetsformer och dess effekt på symtom och hormoner relaterade till psykisk ohälsa.Metod: Litteratursökningen gjordes i PuBMed, PEDro och SweMed+ med sökorden physical therapy modalities, exerciseochstress, psychological. Sökningen resulterade i elva artiklar. Behandlingsmetoderna som studerats är olika former av fysisk aktivitet, fysisk träning och österländsk intervention i form av yoga, qi-gong och andningsövningar. Resultat: Artiklar som tog upp fysisk aktivitet reducerade stressnivån hos försökspersonerna, dock var den inte signifikant (alla p-värden&gt;0.15). Artiklar där fysisk träning ingick visade på en signifikant reducering av ångestkänslighet samt en signifikant kortisolåterhämtning i jämförelse med kontrollgrupperna (p=0.001). Qi-gong visade på en signifikant förbättring gällande depression (p=0.010),ångest (p=0.016) stress (0.009) samt minskning av kortisol i salivet (p=0.012) i jämförelse med kontrollgrupperna. Yoga visade en signifikant minskning av arbetsrelaterad stress (p=0.02) i jämförelse med kontrollgrupperna,Diskussion: Samtliga studier visar att de olika behandlingsformerna ger positiva effekter på tillståndet i någon grad. En trend kunde ses att de senaste tio årens forskning riktat in sig mer på österländska interventioner. Konklusion:Österländsk intervention gav ett generellt högre bevisvärde i jämförelse med de andra interventionerna. Framtida forskning bör använda sig av standardiserade utfallsmått för att underlätta jämförelse mellan studier. Mer vetenskapliga studier med ett längre tidsperspektiv behövs för att se vilka långsiktiga effekter som finns

An epidemiological study of collagenous colitis in southern Sweden from 2001-2010

AIM: To estimate the incidence of collagenous colitis (CC) in southern Sweden during 2001-2010

Sclerosing mesenteritis and mesenteric panniculitis - clinical experience and radiological features

Background: Sclerosing mesenteritis (SM) is sometimes used as an umbrella-term for idiopathic inflammatory conditions in the mesentery. Mesenteric panniculitis (MP) is a radiological finding and its relation to clinical SM is not fully understood. The aims of this study were to determine whether any correlation could be found between the radiological findings and the clinical disease course. Methods: Patients observed due to idiopathic inflammation of the mesentery were identified. If SM could be verified histologically or MP radiologically, the patients were included in this descriptive retro perspective study. Results: Typical radiological changes were observed in 27 patients. A majority (23/27) of these patients had mild to moderate symptoms. This group with typical radiology was labelled MP. Four patients were included due to histologically verified disease but had uncharacteristic radiology involving multiple compartments of the abdomen. All four had marked systemic inflammation, fever and fluctuating radiologic findings. Three had severe disease with multiple hospitalisations and complications but responded promptly to corticosteroids. This group was denoted SM. Conclusions: We have identified two subgroups of patients; firstly, MP with stable and characteristic radiologic changes and secondly SM with atypical radiology and a more aggressive clinical course. We propose that the term SM should be reserved for this latter condition

Chronic non-bloody diarrhoea: a prospective study in Malmö, Sweden, with focus on microscopic colitis.

Chronic non-bloody diarrhoea affects up to 5% of the population. Microscopic colitis is one of the most common causes, encompassing the subtypes collagenous colitis and lymphocytic colitis. The diagnosis of microscopic colitis is made by histological examination of colonic mucosal biopsy specimens. The aim of this investigation was to determine whether laboratory parameters or questions about disease history or concomitant disease could be helpful in discriminating patients with MC from those with a histologically normal colonic mucosa

Elevated fecal levels of eosinophil granule proteins predict collagenous colitis in patients referred to colonoscopy due to chronic non-bloody diarrhea.

Objective Colonoscopy with biopsy sampling is often performed to detect collagenous colitis (CC) and lymphocytic colitis (LC) in patients with chronic non-bloody diarrhea. However, the diagnostic yield is low and incurs high costs. Fecal calprotectin (FC) and myeloperoxidase (MPO) indicate intestinal inflammation in ulcerative colitis (UC) and Crohn's disease (CD). In CC, elevated fecal levels of eosinophil protein X (EPX) and eosinophil cationic protein (ECP) have been reported. We aimed to evaluate if F-EPX, F-ECP, FC, and F-MPO could predict the diagnostic outcome in patients with chronic non-bloody diarrhea referred to colonoscopy. We also evaluated serum (S) EPX and ECP in this regard. Methods Of 67 included patients, 63 (94%) underwent colonoscopy with biopsy sampling. Fecal EPX, F-ECP, FC, F-MPO, S-EPX, and S-ECP were analyzed. Results Diagnostic outcome: normal: n = 46 (73%), CC: n = 9 (14%), LC: n = 4 (6%), UC: n = 2 (3%), CD: n = 2 (3%). Higher levels of F-EPX and F-ECP were found in CC compared to a normal diagnostic outcome (p = 0.01). No change was noted in any of the fecal markers in LC. When all of the fecal markers were normal the probability of a normal diagnostic outcome was 92%. We found no differences in S-EPX and S-ECP between the groups. Conclusion Elevated F-EPX and F-ECP could predict CC. None of the fecal markers predicted LC. Serum-EPX and S-ECP are not useful for the diagnosis of CC, LC, UC, or CD. With normal levels in all of the analyzed fecal markers, there is a low probability of a pathologic diagnostic outcome