ORiginal Article : Cytokine Expression of Microscopic Colitis Including Interleukin-17

( Eunkyoung Park ),( Young Sook Park ),( Dae Rim Park ),( Sung Ae Jung ),( Dong Soo Han ),( Byung Ik Jang ),( Young Ho Kim ),( Won Ho Kim ),( Yun Ju Jo ),( Ki Ho Lee ),( Won Mi Lee ),( Eun Kyung Kim ) The Editorial Office of Gut and Liver 2015 Gut and Liver Vol.9 No.3

Background/Aims: Microscopic colitis is characterized by chronic watery diarrhea with specific pathological changes that can be diagnosed by microscopic examination. We performed immunohistochemical analysis of proinflammatory cytokines to investigate the pathogenic mechanism of microscopic colitis. Methods: This study consisted of six patients with lymphocytic colitis, six patients with collagenous colitis, and six patients with functional diarrhea but normal pathology. We performed an immunohistochemical analysis of the colonic mucosal biopsies to assess the expression of cyclo-oxygenase-2, interleukin-17, nuclear factor-κB, interferon-γ, inducible nitric oxide synthase, and tumor necrosis factor-α. We compared the quantity score of immunohistochemical staining among the groups. Results: The microscopic colitis group showed significantly higher expression of cyclo-oxygenase-2, interleukin-17, nuclear factor-κB, and interferon-γ compared with the control group. Cytokine expression was similar between collagenous colitis and lymphocytic colitis. However, the expression of cyclo-oxygenase-2 was higher in collagenous colitis. Conclusions: Proinflammatory cytokines, including interleukin-17 and interferon-γ, are highly expressed in microscopic colitis. The expression of cyclo-oxygenase-2 was higher in collagenous colitis than in lymphocytic colitis. This study is the first on interleukin-17 expression in microscopic colitis patients. (Gut Liver 2015;9:381-387)

비스테로이드성 소염제의 장기 복용후 생긴 교원성 대장염 1 예

문선희(Sun Hi Moon),김찬규(Chan Gyoo Kim),정준오(Jun Oh Jung),김유선(You Sun Kim),황진혁(Jin Hyok Hwang),김선미(Seon Mie Kim),김병관(Byeong Gwan Kim),박동영(Dong Young Park),정운태(Woon Tae Jeong),이동호(Dong Ho Lee),정현채(Hyun Chae 대한내과학회 1997 대한내과학회지 Vol.53 No.4

Collagenous colitis is characterized clinically by chronic watery diarrhea and pathologically by increased subepithelial collagen deposition associated with an inflammatory infiltrate in the lamina propria. Its etiology is still unclear, although a variety of associated diseases such as rheumatic syndromes, scleroderma, and thyroid diseases have been reported. We report a case of collagenous colitis following the prolonged use of NSAIDs. A 72-year-old woman who has taken NSAIDs for many years due to some dermatologic problems was admitted to the hospital because of chronic watery diarrhea and colicky abdominal pain of 3 months duration. There was no abnormal physical finding except cachectic appearance due to weight loss of 10㎏ during 3 months. Stool examination for ova and parasites and fat was negative, and stool culture for bacterial pathogens was negative. In complete blood count, there were relative eosinophila and mild anemia. Total serum protein and albumin was low, and thyroid function, RA factor, FANA were all normal. Results of upper and lower gastrointestinal contrast radiographs were normal. Sigmoidoscopy revealed normal colonic mucosa but she had a thick subepithelial collagenous deposit and chronic inflammation in lamina propria on colonic biopsy. Based on the above findings, she was diagnosed as collagenous colitis. Diarrhea improved after withdrawing NSAIDs and the treatment with oral prednisolone. In the post-treatment biopsy, the thickness of the collagen hand was diminished. Collagenous colitis is now recognized as one of the common causes of chronic diarrhea of obscure origin and NSAIDs may play an etiological role in some patient with collagenous colitis.

단일 기관에서 경험한 미세 장염의 임상양상 및 특징

이세영 ( Se Young Lee ),전성우 ( Seong Woo Jeon ),정윤진 ( Yun Jin Chung ),박영대 ( Young Dae Park ),윤석진 ( Seok Jin Yoon ),박수영 ( Soo Young Park ),김은수 ( Eun Su Kim ),정민규 ( Min Kyu Jung ),김성국 ( Sung Kook Kim ),최용환 대한내과학회 2008 대한내과학회지 Vol.74 No.4

Background/Aims: Collagenous colitis (CC) and lymphocytic colitis (LC) are characterized by chronic diarrhea and normal radiologic and endoscopic findings. These are currently not uncommon entities whose incidence in increasing as more clinicians take biopsies from macroscopically normal colons. The purpose of this study was to examine the clinical features and characteristics in microscopic colitis. Methods: From January 2003 to December 2006, medical records were reviewed from 80 patients with chronic diarrhea, who had normal colonoscopic findings but underwent biopsy. Patients with microscopic colitis were identified by reviewing the pathology databases and by reviewing biopsies. Results: Microscopic colitis was diagnosed in 12 patients (15%). Six patients with CC (Male:Female=2:4, mean age 54±20.1 years) and 6 patients with LC (Male:Female=5:1, mean age 51.2±21.4 years) were identified. Autoimmune disease was diagnosed in 4 patients (33%). Drug-induced disease was suspected in 3 patients (25%). The inciting drugs were NSAIDs, ticlopidine, ranitidine, and acarbose. Complete or partial resolution of diarrhea was achieved in all patients, including spontaneous resolution in 2 patients. Antidiarrheal drugs, mesalazine, and cholestylamine were highly effective in both diseases. Recurrence of symptoms occurred in 2 patients (17%). They are taking medicine at present. Conclusions: Microscopic colitis is a relatively common cause of chronic diarrhea that appears to be increasing in incidence. We reported clinical features, characteristics, treatment, and response of microscopic colitis in our experience.(Korean J Med 74:397-402, 2008)

Clinical Characteristics of Microscopic Colitis in Korea: Prospective Multicenter Study by KASID

( Young Sook Park ),( Dae Hyun Baek ),( Won Ho Kim ),( Joo Sung Kim ),( Suk Kyun Yang ),( Sung Ae Jung ),( Byung Ik Jang ),( Chnag Hwan Choi ),( Dong Soo Han ),( Young Ho Kim ),( Yong Woo Chung ),( Sa 대한소화기기능성질환·운동학회 2011 Gut and Liver Vol.5 No.2

Background/Aims: Microscopic colitis (MC) encompasses collagenous and lymphocytic colitis and is characterized by chronic diarrhea. In cases of MC, colonic mucosae are macroscopically normal, and diagnostic histopathological features are observed only upon microscopic examination. We designed a prospective multicenter study to determine the clinical features, pathological distribution in the colon and prevalence of MC in Korea. Methods: We prospectively enrolled patients having watery diarrhea no more than 3 times a day between March 2008 and February 2009. We obtained patient histories and performed colonoscopies with random biopsies at each colon segment. Results: A total of 100 patients with chronic diarrhea were enrolled for a normal colonoscopy and stool exam. MC was observed in 22 patients (22%) (M:F 1.2:1; mean age, 47.5 years). Of those 22 patients, 18 had lymphocytic colitis and 4 had collagenous colitis. The entire colon was affected in only 3 cases (13.6%), the ascending colon in 6 cases (27.2%), the transverse colon in 3 cases (13.6%), and the left colon in 3 cases (13.6%). More than 2 segments were affected in 7 cases (31.8%). Nonsteroidal anti-inflammatory drug-associated MCs were observed in 4 cases (18.2%), 3 of which showed improved diarrhea symptoms following discontinuation of the medication. Frequently associated symptoms were abdominal pain and weight loss. Autoimmune diseases were observed in 4 cases (18.2%). Half of the 22 patients with MC improved with conservative care by loperamide or probiotics. Conclusions: In a prospective multicenter study of Korean patients with chronic diarrhea, the frequency of MC was found to be approximately 20%, similar to the percentage observed in Western countries. Therefore, the identification of MC is important for the adequate management of Korean patients with chronic diarrhea. (Gut Liver 2011;5:181-186)

현미경적 대장염; 24명 환자에서의 병리학적 고찰

이선아,정성애,구혜수,강민정 대한병리학회 2009 Journal of Pathology and Translational Medicine Vol.43 No.2

Background : The clinical presentation of microscopic colitis (MC) consists of chronic nonbloody watery diarrhea for weeks or months at a time, abdominal pain, and changes in bowel habits with a normal mucosal appearance upon performing colonoscopy. MC includes two relatively well established histopathologic entities: collagenous colitis (CC) and lymphocytic colitis (LC) as well as atypical forms. The recognition of the microscopic findings of this heterogeneous entity is very important for making the correct diagnosis and providing proper treatment. Methods : We studied the colonoscopic biopsy specimens that were obtained from 26 patients who had clinical findings that were suggestive of MC. Results : Fifteen patients (M: F=9:6) and 9 patients (M:F=5:4) showed the microscopic features of LC and MC, not otherwise specified, respectively. Conclusions : The clinicopathologic findings (the incidence of the subtypes, the patients’ ages and the male/female ratio) of the 24 cases of MC in this study showed differences from the previously reported findings from other countries. Further studies with a sufficient number of patients from multi-centers would be necessary to confirm the regional or ethnic influence.

현미경적 대장염

류한승 ( Han Seung Ryu ),최석채 ( Suck Chei Choi ) 대한내과학회 2015 대한내과학회지 Vol.89 No.6

Microscopic colitis (MC) is a chronic idiopathic inflammatory bowel disease presenting with chronic watery diarrhea. Epidemiologic studies from Western countries have demonstrated that it is almost as common as other classic inflammatory bowel diseases, such as Crohn’s disease and ulcerative colitis. Histological examination can confirm the diagnosis and differentiate between the two main subtypes of MC: collagenous colitis and lymphocytic colitis. The pathophysiology of MC remains unknown; however, possible etiologies include genetic predispositions, autoimmunity, inflammatory responses to luminal factors such as certain drugs or bacteria, and myofibroblast dysregulations. The aim of MC therapy should take into account the severity of symptoms, impact on quality of life, and evidence from clinical trials of available medical treatments. (Korean J Med 2015;89:663-671)

교원성 대장염 환자에서 대장내시경 후 발생한 대장 천공 1예

박윤선 ( Youn Sun Park ),장병익 ( Byung Ik Jang ),김태년 ( Tae Nyeun Kim ),은종렬 ( Jong Ryul Eun ),최재원 ( Jae Won Choi ),이규형 ( Kyu Hyung Lee ),김경옥 ( Kyeong Ok Kim ),이시형 ( Si Hyung Lee ),김미진 ( Mi Jin Kim ) 대한장연구학회 2007 Intestinal Research Vol.5 No.1

Collagenous colitis is a clinicopathological syndrome characterized by: (1) chronic watery diarrhea and crampy abdominal pain and (2) thickened subepithelial collagen band and increased intraepithelial lymphocytes on histology. The mucosa generally appears endoscopically normal, although some nonspecific abnormalities such as patchy erythema, an abnormal vascular pattern or erythema may be found in upto one third of cases. Collagenous colitis is generally regarded as a benign disease and serious complication are uncommon. The frequency of colonic perforation in collagenous coliltis is unknown, but is probably very rare. Only 16 patients, excluding our cases, have so far been reported. We report a case of a 80-year-old woman with collagenous colitis who presented with colonic perforation two days after the colonoscopy. (Intest Res 2007;5:77-80)

만성 설사와 저칼륨혈증으로 발현된 교원성 대장염

백수정 ( Su Jung Baik ),심윤수 ( Yun Su Sim ),정성애 ( Sung Ae Jung ),심기남 ( Ki Nam Shim ),유권 ( Kwon Yoo ),문일환 ( Il Hwan Moon ),한운섭 ( Woon Sup Han ) 대한내과학회 2006 대한내과학회지 Vol.71 No.1

Collagenous colitis is recognized as one of the causes of chronic diarrhea accompanied with autoimmune diseases. It is a disease associated with chronic watery diarrhea and typical histologic findings of a thick subepithelial collagenous deposit on biopsy. We experienced a 75-year-old man patient with chronic watery diarrhea and mild abdominal pain for 7 years. Physical examination, laboratory and radiologic studies were unremarkable except hypokalemia. Colonoscopy disclosed mucosal atrophy, loss of submucosal vessel and altered vascularity of terminal ileum, ascending colon. Colonoscopic biopsy revealed homogenous hyaline layered collagen deposition beneath the surface epithelium and Masson`s trichrome stain showed collagen deposition. We report the case of collagenous colitis with a review of literature.(Korean J Med 71:75-79, 2006)

Prevalence, Pathogenesis, Diagnosis, and Management of Microscopic Colitis

( Nicole Gentile ),( Eugene F. Yen ) 대한간학회 2018 Gut and Liver Vol.12 No.3

Microscopic colitis (MC), which is comprised of lymphocytic colitis and collagenous colitis, is a clinicopathological diagnosis that is commonly encountered in clinical practice during the evaluation and management of chronic diarrhea. With an incidence approaching the incidence of inflammatory bowel disease, physician awareness is necessary, as diagnostic delays result in a poor quality of life and increased health care costs. The physician faces multiple challenges in the diagnosis and management of MC, as these patients frequently relapse after successful treatment. This review article outlines the risk factors associated with MC, the clinical presentation, diagnosis and histologic findings, as well as a proposed treatment algorithm. Prospective studies are required to better understand the natural history and to develop validated histologic endpoints that may be used as end points in future clinical trials and serve to guide patient management. (Gut Liver 2018;12:227-235)

교원성 대장염 2예

박종재,손민수,이성광,박동균,김선숙,김유경,최덕주,박현철,김주현 大韓消化器病學會 1997 大韓消化器病學會誌 Vol.29 No.2