Clinical features and treatment responses in pediatric lymphocytic and collagenous colitis

Nirmala P. Narla, Thomas Christopher Smyrk, Darrell S. Pardi, Jeanne Tung

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

OBJECTIVE:: Microscopic colitis (MC) is prevalent in adults investigated for chronic watery diarrhea, yet characterization of pediatric MC is limited. METHODS:: Our pathology database was searched from 1995 to 2011 for pediatric cases of lymphocytic colitis (LC) or collagenous colitis (CC). Those with diarrhea persisting for >2 weeks and visually normal colonoscopy were accepted as cases. Demographics, laboratory results, medication use within 3 months of presentation, medical and family history of autoimmune disease, and response to treatment were abstracted. RESULTS:: A total of 27 cases were histologically consistent with MC on biopsy; 5 with concomitant enteric infection or isolated abdominal pain were excluded. Twenty-two cases of MC (female patients, 59%; median age at diagnosis, 15.3 years) were included (19 LC and 3 CC). Two had type 1 diabetes mellitus, 2 were anti-nuclear antibody positive, and 2 had common variable immunodeficiency. Of 20 patients who underwent an esophagogastroduodenoscopy, 1 had collagenous sprue and 4 had celiac disease. One presented after the clearance of recurrent Clostridium difficile infection. Previous drug exposures included nonsteroidal anti-inflammatory drugs (n=7), proton pump inhibitors (n=6), and selective serotonin reuptake inhibitors (n=3). Common symptoms in addition to diarrhea included abdominal pain (77.3%) and weight loss (27.3%). Of 17 patients with follow-up, all of the 8 treated with steroids had some response: 57.1% (4/7) responded to mesalamine and 42.9% (3/7) responded to bismuth subsalicylate. CONCLUSIONS:: In this cohort of pediatric patients, LC was much more common than CC. As described in adults, we observed associations with celiac disease, type 1 diabetes mellitus, and medications; we additionally saw an association with immunodeficiency. Our patients showed greater response to steroids than mesalamine or bismuth.

Original languageEnglish (US)
Pages (from-to)557-561
Number of pages5
JournalJournal of Pediatric Gastroenterology and Nutrition
Volume57
Issue number5
DOIs
StatePublished - Nov 2013

Fingerprint

Lymphocytic Colitis
Collagenous Colitis
Microscopic Colitis
Pediatrics
Mesalamine
Diarrhea
Celiac Disease
Type 1 Diabetes Mellitus
Collagenous Sprue
Abdominal Pain
Medical History Taking
Steroids
Common Variable Immunodeficiency
Digestive System Endoscopy
Clostridium Infections
Therapeutics
Bismuth
Clostridium difficile
Proton Pump Inhibitors
Serotonin Uptake Inhibitors

Keywords

  • chronic diarrhea
  • collagenous colitis
  • lymphocytic colitis
  • microscopic colitis
  • pediatric

ASJC Scopus subject areas

  • Gastroenterology
  • Pediatrics, Perinatology, and Child Health

Cite this

Clinical features and treatment responses in pediatric lymphocytic and collagenous colitis. / Narla, Nirmala P.; Smyrk, Thomas Christopher; Pardi, Darrell S.; Tung, Jeanne.

In: Journal of Pediatric Gastroenterology and Nutrition, Vol. 57, No. 5, 11.2013, p. 557-561.

Research output: Contribution to journalArticle

Narla, Nirmala P. ; Smyrk, Thomas Christopher ; Pardi, Darrell S. ; Tung, Jeanne. / Clinical features and treatment responses in pediatric lymphocytic and collagenous colitis. In: Journal of Pediatric Gastroenterology and Nutrition. 2013 ; Vol. 57, No. 5. pp. 557-561.
@article{1e1213e506cd4e9987c912e4a8172d64,
title = "Clinical features and treatment responses in pediatric lymphocytic and collagenous colitis",
abstract = "OBJECTIVE:: Microscopic colitis (MC) is prevalent in adults investigated for chronic watery diarrhea, yet characterization of pediatric MC is limited. METHODS:: Our pathology database was searched from 1995 to 2011 for pediatric cases of lymphocytic colitis (LC) or collagenous colitis (CC). Those with diarrhea persisting for >2 weeks and visually normal colonoscopy were accepted as cases. Demographics, laboratory results, medication use within 3 months of presentation, medical and family history of autoimmune disease, and response to treatment were abstracted. RESULTS:: A total of 27 cases were histologically consistent with MC on biopsy; 5 with concomitant enteric infection or isolated abdominal pain were excluded. Twenty-two cases of MC (female patients, 59{\%}; median age at diagnosis, 15.3 years) were included (19 LC and 3 CC). Two had type 1 diabetes mellitus, 2 were anti-nuclear antibody positive, and 2 had common variable immunodeficiency. Of 20 patients who underwent an esophagogastroduodenoscopy, 1 had collagenous sprue and 4 had celiac disease. One presented after the clearance of recurrent Clostridium difficile infection. Previous drug exposures included nonsteroidal anti-inflammatory drugs (n=7), proton pump inhibitors (n=6), and selective serotonin reuptake inhibitors (n=3). Common symptoms in addition to diarrhea included abdominal pain (77.3{\%}) and weight loss (27.3{\%}). Of 17 patients with follow-up, all of the 8 treated with steroids had some response: 57.1{\%} (4/7) responded to mesalamine and 42.9{\%} (3/7) responded to bismuth subsalicylate. CONCLUSIONS:: In this cohort of pediatric patients, LC was much more common than CC. As described in adults, we observed associations with celiac disease, type 1 diabetes mellitus, and medications; we additionally saw an association with immunodeficiency. Our patients showed greater response to steroids than mesalamine or bismuth.",
keywords = "chronic diarrhea, collagenous colitis, lymphocytic colitis, microscopic colitis, pediatric",
author = "Narla, {Nirmala P.} and Smyrk, {Thomas Christopher} and Pardi, {Darrell S.} and Jeanne Tung",
year = "2013",
month = "11",
doi = "10.1097/MPG.0b013e3182a1df59",
language = "English (US)",
volume = "57",
pages = "557--561",
journal = "Journal of Pediatric Gastroenterology and Nutrition",
issn = "0277-2116",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Clinical features and treatment responses in pediatric lymphocytic and collagenous colitis

AU - Narla, Nirmala P.

AU - Smyrk, Thomas Christopher

AU - Pardi, Darrell S.

AU - Tung, Jeanne

PY - 2013/11

Y1 - 2013/11

N2 - OBJECTIVE:: Microscopic colitis (MC) is prevalent in adults investigated for chronic watery diarrhea, yet characterization of pediatric MC is limited. METHODS:: Our pathology database was searched from 1995 to 2011 for pediatric cases of lymphocytic colitis (LC) or collagenous colitis (CC). Those with diarrhea persisting for >2 weeks and visually normal colonoscopy were accepted as cases. Demographics, laboratory results, medication use within 3 months of presentation, medical and family history of autoimmune disease, and response to treatment were abstracted. RESULTS:: A total of 27 cases were histologically consistent with MC on biopsy; 5 with concomitant enteric infection or isolated abdominal pain were excluded. Twenty-two cases of MC (female patients, 59%; median age at diagnosis, 15.3 years) were included (19 LC and 3 CC). Two had type 1 diabetes mellitus, 2 were anti-nuclear antibody positive, and 2 had common variable immunodeficiency. Of 20 patients who underwent an esophagogastroduodenoscopy, 1 had collagenous sprue and 4 had celiac disease. One presented after the clearance of recurrent Clostridium difficile infection. Previous drug exposures included nonsteroidal anti-inflammatory drugs (n=7), proton pump inhibitors (n=6), and selective serotonin reuptake inhibitors (n=3). Common symptoms in addition to diarrhea included abdominal pain (77.3%) and weight loss (27.3%). Of 17 patients with follow-up, all of the 8 treated with steroids had some response: 57.1% (4/7) responded to mesalamine and 42.9% (3/7) responded to bismuth subsalicylate. CONCLUSIONS:: In this cohort of pediatric patients, LC was much more common than CC. As described in adults, we observed associations with celiac disease, type 1 diabetes mellitus, and medications; we additionally saw an association with immunodeficiency. Our patients showed greater response to steroids than mesalamine or bismuth.

AB - OBJECTIVE:: Microscopic colitis (MC) is prevalent in adults investigated for chronic watery diarrhea, yet characterization of pediatric MC is limited. METHODS:: Our pathology database was searched from 1995 to 2011 for pediatric cases of lymphocytic colitis (LC) or collagenous colitis (CC). Those with diarrhea persisting for >2 weeks and visually normal colonoscopy were accepted as cases. Demographics, laboratory results, medication use within 3 months of presentation, medical and family history of autoimmune disease, and response to treatment were abstracted. RESULTS:: A total of 27 cases were histologically consistent with MC on biopsy; 5 with concomitant enteric infection or isolated abdominal pain were excluded. Twenty-two cases of MC (female patients, 59%; median age at diagnosis, 15.3 years) were included (19 LC and 3 CC). Two had type 1 diabetes mellitus, 2 were anti-nuclear antibody positive, and 2 had common variable immunodeficiency. Of 20 patients who underwent an esophagogastroduodenoscopy, 1 had collagenous sprue and 4 had celiac disease. One presented after the clearance of recurrent Clostridium difficile infection. Previous drug exposures included nonsteroidal anti-inflammatory drugs (n=7), proton pump inhibitors (n=6), and selective serotonin reuptake inhibitors (n=3). Common symptoms in addition to diarrhea included abdominal pain (77.3%) and weight loss (27.3%). Of 17 patients with follow-up, all of the 8 treated with steroids had some response: 57.1% (4/7) responded to mesalamine and 42.9% (3/7) responded to bismuth subsalicylate. CONCLUSIONS:: In this cohort of pediatric patients, LC was much more common than CC. As described in adults, we observed associations with celiac disease, type 1 diabetes mellitus, and medications; we additionally saw an association with immunodeficiency. Our patients showed greater response to steroids than mesalamine or bismuth.

KW - chronic diarrhea

KW - collagenous colitis

KW - lymphocytic colitis

KW - microscopic colitis

KW - pediatric

UR - http://www.scopus.com/inward/record.url?scp=84888137014&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84888137014&partnerID=8YFLogxK

U2 - 10.1097/MPG.0b013e3182a1df59

DO - 10.1097/MPG.0b013e3182a1df59

M3 - Article

VL - 57

SP - 557

EP - 561

JO - Journal of Pediatric Gastroenterology and Nutrition

JF - Journal of Pediatric Gastroenterology and Nutrition

SN - 0277-2116

IS - 5

ER -