Collagenous colitis

The collagenous colitis ( synonyms: collagenous colitis, Kollagencolitis, microscopic colitis ) is a suspected chronic, something atypical running inflammation of the lining of the colon, the cause is not clear as before and the clinically with severe watery diarrhea ( diarrhea) accompanied.

The special feature of the disease is the excessive formation of a ( physiologically present in every human being, but only a few micrometers thick ) membrane that normally separates the mucosal epithelial of the underlying layers of the intestinal wall. This membrane thickens monstrous in collagen colitis and then basically consists of repair collagens, such as occur in scarring. The genesis of the diarrhea is still not clear, but this thickened membrane is likely there certainly play a part. The first description was in 1976 by ​​Lindström.

Directly related and probably identical with the collagens colitis lymphocytic colitis with the same clinical picture, in which histologically but not the membrane thickening is in the foreground, but an infiltrate of lymphocytes in the mucosa, that there is not normally found.

Causes

There are two basic theories on the origin of the disorder: one states that an autoimmune process is in the foreground, the body that is of unknown cause ( partly genetic) turns against itself and the body's own cells misinterpreted as foreign cells and therefore fights ( other examples: various thyroid diseases, diseases of rheumatic and last but not least, the classic inflammatory bowel diseases (IBD ) such as Crohn's disease and ulcerative colitis). The result of the fight is said inflammatory response. The second theory assumes a far undiscovered bacteria or virus that causes chronic infection as part of an inflammatory response to said. Also may be a connection to a celiac.

Meanwhile, the consensus view is more in the direction of the first variant, ie the autoimmune events. At the bacterial / viral etiology believe hardly anyone, even if it can not be excluded that in the beginning of the reaction chain, a transient intestinal infection is, which then flows through partially autoimmune processes in the chronic inflammation. It can therefore be assumed to be multifactorial events most likely.

Therapy

Therapeutically, a concept has emerged, which essentially corresponds to the procedure in Crohn's disease: A combination treatment of cortisone and 5-aminosalicylic acid (classic: budesonide or prednisolone and mesalazine ). The basic idea is to break the inflammatory response with a short-term high -dose administration, and then to keep up with maintenance therapy in check, the regime must each be tailored to the individual case.

Dietary measures generally bring nothing, unless the patient is individually stated that he tolerates certain things less well than others. Other forms of therapy have proven over the last 25 years as being ineffective. As symptomatic treatment for the diarrhea does not make much meaningful except loperamide and activated charcoal administration, but experience shows that also improve with reduction of the inflammatory situation, the diarrhea.

If the diagnosis by means of multiple sampling in the context of one or more of several colonoscopy (s) is actually secured and the patient is affected by the diarrhea clear in his well-being, anti- inflammatory treatment should be initiated if necessary. When the diagnosis has been confirmed, should be considered together with a gastroenterologist about which method is best individually.