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Collagenous Colitis

Disease Details

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Description: Collagenous colitis is a type of inflammatory bowel disease characterized by chronic watery diarrhea and the presence of a thick layer of collagen in the colon lining.
Type: Collagenous colitis is not typically considered a genetically transmitted disease. It is classified as a form of microscopic colitis, which is an inflammatory bowel disease. While there may be a genetic predisposition in some individuals, it is generally believed to result from a combination of genetic, environmental, and immunological factors rather than direct genetic transmission.
Signs And Symptoms: In general, microscopic colitis causes chronic watery diarrhea with increased stool frequency. Some patients report nocturnal diarrhea, abdominal pain, bowel urgency, fecal incontinence, fatigue and weight loss. In severe cases, symptoms may include dehydration and electrolyte imbalances. Patients report a significantly diminished quality of life. In a retrospective study specifically on collagenous colitis patients, all studied patients experienced chronic diarrhea, 42% experienced weight loss, 41% experienced abdominal pain, 27% of the patients experienced nocturnal diarrhea, while 14% experienced fatigue and 8% experienced meteorism. The median patent had 6 stools per day. Among the patients who experienced weight loss and whose magnitude of weight loss was recorded, the median lost weight was 6 kg.
Prognosis: Collagenous colitis generally has a good prognosis. It is a chronic but manageable inflammatory bowel condition primarily affecting the colon. Symptoms, including chronic watery diarrhea, can be effectively controlled with medication, dietary changes, and lifestyle adjustments. While it may have periods of remission and relapse, it is not associated with an increased risk of colon cancer or other serious long-term complications. Lifelong management may be required, but the quality of life can remain high with appropriate treatment.
Onset: The onset of collagenous colitis is typically insidious, often affecting individuals in middle age or older, with a slight female predominance. Patients usually develop symptoms gradually over weeks to months.
Prevalence: The prevalence of collagenous colitis is estimated to be between 3 to 5 cases per 100,000 person-years.
Epidemiology: One epidemiological study reported previous incidence rates of collagenous colitis found in the literature as ranging from 0.6 cases per 100,000 person-years (based on French data from 1987–1992) to 5.2 per 100,000 person-years (from an Icelandic study based on data from 1995-1999), while the authors themselves found an incidence rate of 3.1 per 100,000 person-years in Olmsted County, Minnesota across the period 1985-2001. Based only on the subset of the data from 1998-2001, however, the authors found a higher rate of 7.1 per 100,000 person-years, an incidence rate which exceeded those of Crohn's disease and ulcerative colitis. The previously mentioned Icelandic study also found increasing rates through the studied period, with the incidence rate in Iceland increasing from 2.2 in 1995 to 8.3 in 1999. Women appear to be more frequently affected by collagenous colitis than men, with the Icelandic study finding a female-male ratio of 7.9 in diagnosed cases and the Olmsted County study finding a female-male ratio of 4.4.An updated study on microscopic colitis in Olmsted County published in 2022 and based on data from between 2011 and 2019 found an incidence rate for collagenous colitis of 9.9 cases per 100,000 person-years, a prevalence of 100.1 per 100,000 persons and a female-male ratio of 4.7. Unlike in the previous study on data from 1995-1999, the rate of collagenous colitis in Olmsted County was found to have remained stable between 2011 and 2019. Another study on rates of microscopic colitis in Denmark between 2001 and 2016 found an overall incidence rate for collagenous colitis of 12.2 per 100,000 person-years, a prevalence of 116.7 per 100,000 persons and a female-male ratio of 3.1. Like the 1995-1999 Olmsted County study and the 1995-1999 Icelandic study, this Danish study found a heavy increase in rates of collagenous colitis and microscopic colitis overall during the studied period, with the incidence rates in 2001 and 2016 for microscopic colitis found to be, respectively, 2.3 and 24.3 cases per 100,000 person-years. However, the incidence rates of collagenous colitis in this Danish data peaked in 2011 with a rate of 19.6 cases per 100,000 person-years, and rates appeared to be stable between 2012 and 2016. The average age at diagnosis was found to be 67, and the highest incidence rate was found among patients over the age of 80. The strong increase in the case rates of microscopic colitis (with collagenous colitis making up 59% of these cases) throughout the study period meant that by 2016, microscopic colitis had a greater incidence rate in Denmark than did Crohn's disease and ulcerative colitis. The authors suggest an increase in the use of colonoscopies as a possible cause of the observed change in microscopic colitis diagnoses over time.
Intractability: Collagenous colitis is generally not considered intractable. It is a chronic condition that can often be managed effectively with medication and lifestyle changes. Treatment typically includes dietary modifications, anti-inflammatory medications, and sometimes corticosteroids. While it can be a persistent condition with periods of remission and relapse, it is generally responsive to treatment and can be effectively managed in most patients.
Disease Severity: Collagenous colitis is generally considered to be a mild to moderate disease. It often causes chronic, non-bloody diarrhea, but patients typically do not experience severe pain or weight loss. The severity can vary between individuals, and symptoms may come and go. Treatment can help manage symptoms and improve quality of life.
Healthcare Professionals: Disease Ontology ID - DOID:0060183
Pathophysiology: Collagenous colitis is a form of microscopic colitis characterized by chronic, non-bloody watery diarrhea. The pathophysiology involves the thickening of the subepithelial collagen layer in the colon. This thickened collagen layer disrupts the normal absorption of water and electrolytes, leading to diarrhea. The exact cause is unknown but is thought to involve a combination of immune-mediated processes, genetic predisposition, and environmental factors. Chronic inflammation and abnormal immune responses likely contribute to the deposition of collagen.
Carrier Status: Collagenous colitis is not known to have a carrier status as it is not a genetic disease that is passed down in a carrier fashion. It is a type of inflammatory bowel disease characterized by chronic, watery diarrhea and a thickened layer of collagen in the colon lining. The exact cause is unclear, but it may involve a combination of genetic susceptibility, autoimmune responses, and environmental factors.
Mechanism: Collagenous colitis is a form of microscopic colitis characterized by chronic watery diarrhea. The mechanism involves inflammation of the colon and thickening of the subepithelial collagen layer.

On a molecular level, several factors contribute to its pathogenesis:

1. **Immunologic Factors:** There appears to be an immune-mediated component, with an increase in intraepithelial lymphocytes and cytokine production, particularly involving Th1 and Th17 pathways.

2. **Matrix Metalloproteinases (MMPs):** These enzymes, particularly MMP-9, can degrade the extracellular matrix and are thought to contribute to the deposition of the collagen layer.

3. **Genetic Susceptibility:** Certain HLA haplotypes may predispose individuals to developing collagenous colitis.

4. **Epithelial Barrier Dysfunction:** Altered permeability of the intestinal epithelial barrier allows antigens to penetrate and stimulate an inflammatory response.

5. **Gut Microbiota:** Alterations in the composition of the gut microbiome have also been implicated, as they might influence immune responses and inflammation.

Overall, collagenous colitis results from a combination of genetic, immunologic, and environmental factors leading to chronic inflammation and collagen deposition in the colon.
Treatment: First line treatment for collagenous colitis is the use of budesonide, a steroid that works locally in the colon and is highly cleared by first pass effect. Other medications that can be used include the following:
Bismuth agents, including Pepto-Bismol
5-aminosalicylic acid
Immunosuppressants, including azathioprine
InfliximabPilot-scale studies have shown some evidence of possible benefit for both Boswellia serrata extract and specific strains of probiotics in the treatment of collagenous colitis, although larger sample sizes are needed to confirm the results.
Compassionate Use Treatment: For collagenous colitis, compassionate use and experimental treatments may include:

1. **Biologic Agents**: Medications such as infliximab and vedolizumab, typically used for other inflammatory bowel diseases, have been explored in cases refractory to standard treatments.

2. **Budesonide**: Although already a standard treatment, continuous use at low doses (off-label) has been considered for maintenance therapy in chronic cases.

3. **Fecal Microbiota Transplantation (FMT)**: Still experimental, FMT involves transferring stool from a healthy donor to restore gut microbiota balance and has shown potential in treating refractory collagenous colitis.

4. **Immunomodulators**: Drugs like azathioprine or methotrexate, generally used for immune suppression in other conditions, have been tried off-label.

It's important to consult with a healthcare professional for guidance on these treatments.
Lifestyle Recommendations: Lifestyle recommendations for managing collagenous colitis include:

1. **Dietary Modifications**:
- Adopt a low-fat, low-fiber diet to reduce the frequency and severity of diarrhea.
- Avoid irritating foods and drinks, such as caffeine, alcohol, and spicy foods.
- Consider eliminating dairy if lactose intolerance is suspected.

2. **Hydration**:
- Maintain good hydration, especially during episodes of diarrhea.

3. **Stress Management**:
- Engage in stress-reducing activities such as yoga, meditation, or deep-breathing exercises.

4. **Medication Adherence**:
- Follow prescribed treatments and medications as directed by your healthcare provider.

5. **Avoid NSAIDs**:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) can exacerbate symptoms; consider alternative pain relief options after consulting your doctor.

6. **Regular Follow-ups**:
- Keep regular appointments with your healthcare provider to monitor and adjust your treatment as necessary.
Medication: Medication for collagenous colitis typically includes:

- **Anti-diarrheal agents**: such as loperamide to help control diarrhea.
- **Bile acid binders**: like cholestyramine, which can reduce diarrhea.
- **Corticosteroids**: such as budesonide, to reduce inflammation in the colon.
- **Aminosalicylates**: like mesalamine, which are anti-inflammatory medications.
- **Immunosuppressive agents**: such as azathioprine or methotrexate for more severe cases.

Always consult a healthcare provider for a treatment plan tailored to individual needs.
Repurposable Drugs: Repurposable drugs for collagenous colitis include bismuth subsalicylate, budesonide, and mesalamine. These medications, originally used for other gastrointestinal conditions, have shown efficacy in managing symptoms of collagenous colitis.
Metabolites: For collagenous colitis, specific metabolite information is limited in the context of the disease. Generally, collagenous colitis is associated with chronic inflammation of the colon, and individual metabolic profiles might vary. Treatment often includes medications such as budesonide or bismuth subsalicylate rather than specific metabolite monitoring or therapy.
Nutraceuticals: Collagenous colitis is a type of inflammatory bowel disease characterized by chronic non-bloody watery diarrhea. Nutraceuticals, which are products derived from food sources that offer additional health benefits, have limited specific evidence for treating collagenous colitis. Standard treatment usually involves medications like budesonide or dietary changes. If considering nutraceuticals, it might be prudent to discuss options like probiotics or anti-inflammatory supplements with a healthcare provider, although their effectiveness is not well-established for this condition.
Peptides: Collagenous colitis involves inflammation of the colon's lining, characterized by a thickened collagen layer. There is no direct treatment using peptides specifically for this condition. However, ongoing research is looking into various therapeutic avenues, including the role of peptides in gut health. Standard treatments involve medications like budesonide or bismuth subsalicylate to manage symptoms.