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  • 1.
    Bohr, Johan
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län. Division of Gastroenterology, Department of Medicine, Örebro University Hospital, Örebro, Sweden.
    Wickbom, Anna
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Division of Gastroenterology, Department of Medicine, Örebro University Hospital, Örebro, Sweden.
    Hegedus, Agnes
    Department of Laboratory Medicine/Pathology, Örebro University Hospital, Örebro, Sweden.
    Nyhlin, Nils
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Division of Gastroenterology, Department of Medicine, Örebro University Hospital, Örebro, Sweden.
    Hultgren-Hörnquist, Elisabeth
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Tysk, Curt
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Division of Gastroenterology, Department of Medicine, Örebro University Hospital, Örebro, Sweden.
    Diagnosis and management of microscopic colitis: Current perspectives2014Inngår i: Clinical and Experimental Gastroenterology, ISSN 1178-7023, E-ISSN 1178-7023, Vol. 7, s. 273-284Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Collagenous colitis and lymphocytic colitis, together constituting microscopic colitis, are common causes of chronic diarrhea. They are characterized clinically by chronic nonbloody diarrhea and a macroscopically normal colonic mucosa where characteristic histopathological findings are seen. Previously considered rare, they now have emerged as common disorders that need to be considered in the investigation of the patient with chronic diarrhea. The annual incidence of each disorder is five to ten per 100,000 inhabitants, with a peak incidence in 60- to 70-year-old individuals and a predominance of female patients in collagenous colitis. The etiology and pathophysiology are not well understood, and the current view suggests an uncontrolled mucosal immune reaction to various luminal agents in predisposed individuals. Clinical symptoms comprise chronic diarrhea, abdominal pain, fatigue, weight loss, and fecal incontinence that may impair the patient's health-related quality of life. An association is reported with other autoimmune disorders, such as celiac disease, thyroid disorders, diabetes mellitus, and arthritis. The best-documented treatment, both short-term and long-term, is budesonide, which induces clinical remission in up to 80% of patients after 8 weeks' treatment. However, after successful budesonide therapy is ended, recurrence of clinical symptoms is common, and the best possible long-term management deserves further study. The long-term prognosis is good, and the risk of complications, including colonic cancer, is low. We present an update of the epidemiology, pathogenesis, diagnosis, and management of microscopic colitis.

  • 2. Münch, Andreas
    et al.
    Bohr, Johan
    Region Örebro län. Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Vigren, Lina
    Tysk, Curt
    Region Örebro län. Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Ström, Magnus
    Lack of effect of methotrexate in budesonide-refractory collagenous colitis2013Inngår i: Clinical and Experimental Gastroenterology, ISSN 1178-7023, E-ISSN 1178-7023, Vol. 6, s. 149-52Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: In most cases, collagenous colitis can be treated effectively with budesonide. However, some patients develop side effects or have chronic symptoms refractory to budesonide. This paper reports an open case series of patients intolerant or refractory to budesonide who were treated with methotrexate (MTX).

    METHODS AND PATIENTS: Nine patients (seven women) with a median (range) age of 62 (44-77) years were studied. Bowel movements were registered during 1 week prior to baseline and after 6 and 12 weeks' treatment, enabling calculation of the mean bowel movements/day. All patients underwent colonoscopy with biopsies before inclusion to confirm diagnosis. Open treatment with MTX was given 15 mg subcutaneously weekly for 6 weeks and was increased to 25 mg for a further 6 weeks if symptoms were unresponsive to the first 6 weeks' treatment. The endpoint was clinical remission, which was defined as a mean <3 stools/day and mean <1 watery stool/day/week at Week 12. The Short Health Scale was used at baseline and Week 12 to assess health-related quality of life.

    RESULTS: Five patients fulfilled the treatment according to the protocol and four patients discontinued the study after 3-6 weeks because of adverse events. No patient achieved clinical remission at Week 12. The mean stool frequency/day at baseline was 6.0 stools/day, thereof 5.4 watery stools/day and after 12 weeks treatment 6.4 stools/day, thereof 5.7 watery/day. No patient appreciated an improvement of health-related quality of life.

    CONCLUSION: Short-term treatment with MTX had no clinical effect in collagenous colitis patients intolerant or refractory to budesonide. Alternative therapies should be investigated in these patients.

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