RESUMO
A 56-year-old Caucasian woman presented with epigastric pain, watery diarrhoea, bloating and flatulence following treatment with duloxetine and venlafaxine for anxiety and depression. Abdominal examination was benign. Blood work revealed haemoglobin of 96â g/L (115-160â g/L), iron 6â µmol/L (10-33â µmol/L), transferrin saturation 0.08 (0.20-0.55), ferritin 26â µg/L (15-180â µg/L), albumin 46â g/L (35-50â g/L), pre-albumin 293â mg/L (170-370â mg/L), total IgA 2.64â g/L (0.78-3.58â g/L) and anti-tTG IgA 5â units (<20â units). Faecal occult blood tests were 3/3 positive and stool cultures were negative. CT enterography was normal. Colonic biopsy revealed collagenous colitis, while duodenal biopsy showed collagenous sprue with blunted to completely flattened villi and markedly thickened subepithelial collagen table entrapping capillaries and lymphocytes. The patient started a gluten-free diet, loperamide and ferrous gluconate. Her symptoms resolved and a faecal immunochemical test performed 6â months later was negative.
Assuntos
Anemia Ferropriva/diagnóstico , Colite Colagenosa/diagnóstico , Colágeno/metabolismo , Espru Colágeno/diagnóstico , Diarreia/diagnóstico , Enterocolite/diagnóstico , Mucosa Intestinal/patologia , Anemia Ferropriva/etiologia , Biópsia , Colite Colagenosa/complicações , Colite Colagenosa/dietoterapia , Colite Colagenosa/patologia , Espru Colágeno/complicações , Espru Colágeno/dietoterapia , Espru Colágeno/patologia , Colo/patologia , Diarreia/etiologia , Dieta Livre de Glúten , Duodeno/patologia , Enterocolite/complicações , Enterocolite/dietoterapia , Enterocolite/patologia , Feminino , Humanos , Pessoa de Meia-IdadeAssuntos
Colite Colagenosa/patologia , Colo Ascendente/patologia , Células Gigantes/patologia , Mucosa Intestinal/patologia , Idoso , Colite Colagenosa/complicações , Colite Colagenosa/dietoterapia , Colite Colagenosa/fisiopatologia , Colonoscopia , Diarreia/etiologia , Fibras na Dieta/uso terapêutico , Feminino , Humanos , Resultado do TratamentoRESUMO
BACKGROUND & AIMS: Collagenous sprue (CS) is characterized by the presence of a distinctive band of subepithelial collagen deposition in the small bowel. We evaluated the clinical characteristics, treatments, and outcomes of patients with CS. METHODS: Thirty patients with CS were identified at the 3 Mayo Clinic sites between 1993 and 2009. Clinical data from medical records were reviewed. RESULTS: The study cohort was 70% female (age range, 53-91 years). Most patients had severe diarrhea and weight loss. Hospitalization to treat dehydration was necessary in 16 (53%) patients. Associated immune-mediated diseases were noted in 70% of the patients; celiac disease was the most frequent. Other associated diseases were microscopic colitis, hypothyroidism, and autoimmune enteropathy. The median thickness of the layer of subepithelial collagen deposition in the small bowel was 29 mum (20-56.5 mum). Subepithelial collagen deposition in the colon or stomach was noted in 8 patients. A clinical response was observed in 24 (80%) patients after treatment with a combination of a gluten-free diet and immunosuppressive drugs. Histologic improvement was confirmed in 9 patients, with complete remission in 5. Two patients died (1 of complications of CS and 1 of another illness). CONCLUSIONS: Most patients with CS are treated effectively with a combination of gluten-free diet and steroids. CS is often associated with collagen deposition or chronic inflammation in other segments of the gastrointestinal tract as well as other immune-mediated disorders.