Comparison of effectiveness and discontinuation of interferon-free therapy for hepatitis C in prison inmates and noninmates.

Chronic hepatitis C treatment with direct acting antiviral (DAA) therapy during incarceration is an attractive option, due to its short duration and to the possibility of directly observed treatment or supervision. The aim of this study is to compare the effectiveness and rates of discontinuation of DAA treatment in prisoners and nonprisoners. We studied all patients treated in the 10 prisons of Catalonia and at 3 public hospitals in the Barcelona area between 1 January 2015 and 30 April 2016. We analysed sustained viral response (SVR) and rates of discontinuation through intention-to-treat and modified-intention-to-treat analyses, the latter excluding discontinuations due to release from prison. One hundred and eighty-eight inmates and 862 noninmates were included. Prisoners were significantly younger than nonprisoners, with higher proportions of men, drug users, HIV infection, genotypes 1a and 3 and more treatment with psychiatric drugs. Overall, 98.4% of patients completed treatment. The discontinuation rate was low, but higher in inmates (3.7% vs 1.2% noninmates; P = .003) and in community patients >65 years old (2.8% vs 1.2% in under 65 seconds; P = .008). Among the inmates, 7 (42.8%) discontinuations were due to release. SVR was 93.1% in inmates vs 96.5% in noninmates (P = .08) by intention-to-treat and 95.1% vs 96.5% (P = .37) by modified intention-to-treat. Virologic failure rates were similar (3.8% vs 3% in noninmates; P = .60). SVR, virologic failure and discontinuation rates were similar in inmates and noninmates. Currently, prisons are considered a priority for the implementation of DAA. Improved coordination between penitentiary and community health systems would help to ensure therapeutic continuity in released prisoners.

Risk of acute liver injury associated with the use of drugs: a multicentre population survey.

BACKGROUND: Acute liver injury of uncertain aetiology is often drug related and quantitative information about the associated risk is scarce. AIM: To estimate the risk of acute liver injury associated with the use of drugs. METHODS: In a population survey study, 126 cases of acute liver injury were prospectively assembled from January 1993 to December 1999, in patients over 15 years of age, in 12 hospitals in Barcelona (Spain). We estimated the relative risk for each drug as the ratio between the incidence of acute liver injury among the exposed population to the drug and the incidence of acute liver injury among those not exposed to it. Drug consumption data were used to estimate the exposed population. RESULTS: Isoniazid, pyrazinamide, rifampicin, amoxicillin with clavulanic acid, erythromicin, chlorpromazine, nimesulide, and ticlopidine presented the highest risk (point relative risk > 25). Amoxicillin, metoclopramide, captopril and enalapril, furosemide, hydrochlorothiazide, fluoxetine, paroxetine, diazepam, alprazolam, lorazepam, metamizole, low-dose acetylsalicylic acid and salbutamol showed the lowest risk (point relative risk < 5). CONCLUSIONS: This study provides a risk estimation of serious liver disease for various drugs that will be useful in its diagnosis and management, and when comparing with the drug therapeutic benefit in each indication. Some observed associations would be worth specific studies.

Comparison of a monoclonal with a polyclonal antibody-based enzyme immunoassay stool test in diagnosing Helicobacter pylori infection before and after eradication therapy.

BACKGROUND: Detection of Helicobacter pylori antigen in stool samples has been a subject of controversy. However, it has been included in several clinical guidelines as a recommended non-invasive testing procedure in dyspeptic patients. AIM: To compare a monoclonal enzyme immunoassay for detection of H. pylori stool antigen (Amplified IDEIA HpStAR, DakoCytomation) with a polyclonal enzyme immunoassay (HpSA test, Premier Platinum HpSA, Meridian Diagnostics) in diagnosing infection and in determining H. pylori status after eradication treatment. METHODS: We evaluated stool samples of 198 patients diagnosed with H. pylori infection and of 41 patients without infection. The results of the monoclonal enzyme immunoassay HpStAR were compared with those of the polyclonal enzyme immunoassay HpSA. RESULTS: The sensitivity and specificity of HpStAR were 91.9% and 70.7%, while those of HpSA were 89.4% and 80.5%, respectively. In the 126 patients evaluated 6 weeks after eradication therapy, the overall agreement between urea breath test and HpStAR was 90.5% (P = 0.710) and between urea breath test and HpSA was 76.9% (P = 0.410). CONCLUSIONS: HpStAR is a rapid and easy-to-perform test with similar sensitivity to HpSA in the diagnosis of H. pylori infection, although it had lower specificity. In contrast, HpStAR is more accurate after eradication therapy than HpSA.

[Gastric ulcer as a unique and symptomatic manifestation of infection by cytomegalovirus in a healthy adult]. / Ulceras gástricas como manifestación única y sintomática de infección por citomegalovirus en un adulto sano.

A previously healthy female without risk factors had cytomegalic inclusion disease with symptomatic gastric involvement and without evidence of systemic cytomegalovirus (CMV) infection. Multiple ulcerations with a fibrinous bottom were discovered by fibrogastroscopy in the gastric body and antrum. Histological study showed cells with intranuclear inclusions and basophilic nuclear cytoplasm. The detection of specific IgM and its subsequent negativization suggest an active CMV infection. Gastric infection may be the isolated and symptomatic feature of the disease in the healthy adult.

[Percutaneous endoscopic gastrostomy: study on 35 patients]. / Gastrostomía endoscópica percutánea: estudio de 35 enfermos.

BACKGROUND: A review of the technique, indications, complications and follow up of percutaneous endoscopic gastrostomy (PEG) was performed. METHODS: Thirty-five patients in whom a PEG had been placed according to the Ponsky technique from 1991 to 1993 were analyzed 27 of whom had neurologic disease, 6 tumoral diseases and 2 other causes. RESULTS: PEG was carried out in 33 patients with no incidences while the technique could not be performed in 2 since the point could not be identified by transillumination in the gastric wall. No immediate complications were observed. Seven minor early complications were presented as wound infection with the cannula being withdrawn in only one case due to persistence of the infection. Five late complications were reported: 1 severe (gastrocholic fistula) and 4 minor (2 cannula obstructions, 1 displacement and 1 infection). Evolution was followed in 31 patients with the cannula being withdrawn in 4 (2 because of complications and in the other 2 on initiation of oral diet). The cannula was substituted at 120 and 360 days in 2 patients. Sixteen patients died, 5 during the first 30 days due to the primary disease, with only one case (aspirative pneumonia) being related to the PEG. The PEG continues functioning in 11 patients. CONCLUSIONS: Percutaneous endoscopic gastrostomy for feeding is a simple technique which may be carried out in most patients with scarce severe complications, allowing a good nutritional state and improving the quality of life of patients requiring prolonged enteral feeding.

[The endoscopic treatment of postcholecystectomy biliary leakage]. / Tratamiento endoscópico de la fuga biliar poscolecistectomía.

Although there is a decrease in the total number of complications observed on performance of laparoscopy cholecystectomy (LC) there does appear to be an increase in biliary tract lesions. Seven cases of postcholecystectomy biliary leakage treated with endoscopic methods are presented. These cases include 4 patients with leakage from the cystic canal stump and 3 with leakage from the common bile duct. In 5 cases the biliary tract lesion occurred following LC, 1 after conventional cholecystectomy and in 1 reconverted LP. CPRE identified the site of the leakage in the 7 patients and in 2 residual choledocholithiasis. In 5 cases treatment consisted in endoscopic papillotomy and placement of biliary endoprosthesis while only papillotomy was performed in 2 patients. In one of these cases CPRE was repeated and the sphincterotomy widened due to persistence of the leakage at 5 days, with the same finally closing at 15 days of the second CPRE. Closure of the biliary leakage was obtained in the other 6 cases in less than 72 hours post-CPRE. No complications secondary to the technique were observed. It was concluded that CPRE together with endoscopic papillotomy and placement of biliary prostheses is an effective and safe treatment for postcholecystectomy biliary leakages of the common bile duct or cystic duct.

[Endoscopic ligation with elastic bands in the prevention of hemorrhage recurrence caused by esophageal varices. Study of 45 patients]. / Ligadura endoscópica con bandas elásticas en la prevención de la recidiva hemorrágica por varices esofágicas. Estudio en 45 pacientes.

The aim of the present study was to determine the usefulness of elastic band ligation in the prevention of hemorrhage recurrence by esophageal varices. Forty-five patients without known hepatocarcinoma who had survived a hemorrhagic variceal episode were included in the study. Seventeen patients (38%) were Child-Pugh A, 22 (49%) B, and 6 (13%) C, with the hepatitis C virus and alcohol being the etiology of cirrosis in 55 and 20% of the cases, respectively. The first ligation session was performed between the third and fifth days after the hemorrhagic episode and the posterior sessions were carried out at intervals of 2-4 weeks. The ligation sessions were performed without antibiotic prophylaxis and with placement of an overtube. A mean of 4 +/- 2 bands were placed per session (range, 1-8) and the mean number of sessions required per patient to achieve erradication of the varices was 3.5 +/- 1.5 (range, 2-8). The rate of bleeding recurrence was 17.7% (9 episodes, five by variceal rupture and four by ulcer secondary to ligation). All the episodes of bleeding recurrence occurred between the sessions, with the mortality being 11% (5/45 patients). In the 40 remaining patients the varices were erradicated although 19 (47.5%) required one or two additional sessions of sclerotherapy. The accumulated percentage of patients free of bleeding recurrence was 82% during a mean follow-up of 10.2 +/- 6.7 months. Ten lesions of dislaceration of the esophageal mucosa caused by placement of the were observed overtube. In conclusion, endoscopic elastic band ligation is a useful technique for the erradication of esophageal varices an in the prevention of bleeding recurrence.

[The evaluation of a new immunoenzyme analysis for the detection of Helicobacter pylori infection in stool samples]. / Evaluación de un nuevo enzimoinmunoanálisis para la detección de la infección por Helicobacter pylori en muestras fecales.

BACKGROUND: Detection of bacterial antigen in stool specimens (HpSAT) is a new promising tool for diagnosing Helicobacter pylori infection. OBJECTIVE: To evaluate diagnostic accuracy of HpSAT in the diagnosis of Helicobacter pylori infection. PATIENTS AND METHODS: We evaluate the presence of Helicobacter pylori infection by the rapid urease test and the 13C-urea breath test in endoscopic biopsies. Patients who were positive for both tests were considered to have Helicobacter pylori infection. Patients negative for both tests were considered free of infection. The presence of Helicobacter pylori infection was also determined in stool specimens by means of HpSAT. RESULTS: The sensitivity of HpSAT was 92.8%, the specificity 92.3%, the positive predictive value 98.1% and the negative predictive value 75%. CONCLUSIONS: HpSAT is a reliable tool for diagnosing Helicobacter pylori infection.

[The attitude of primary health care physicians in the metropolitan area of Barcelona about the diagnosis and treatment of Helicobacter pylori infection in gastroduodenal diseases]. / Actitud de los médicos de atención primaria del área metropolitana de Barcelona frente al diagnóstico y tratamiento de la infección por Helicobacter pylori en enfermedades gastroduodenales.

AIM: To evaluate the attitude of primary health care physicians versus the diagnosis and treatment of infection by Helicobacter pylori in patients with dyspepsia and gastroduodenal ulcer. DESIGN: An observational, transversal study was performed by a self administered questionnaire from June to October, 1997. PARTICIPANTS: Primary health care physicians from 38 reformed Medical Centers in the metropolitan area of Barcelona were included in the study. RESULTS: Of the 359 doctors to whom the questionnaire was sent, 283 responded (78.8%). In a patient with dyspepsia 95.4% would first request endoscopy. If they knew of the presence of infection by Helicobacter pylori 96.1% would administer eradication treatment in patients with gastric and duodenal ulcer and 15% would also do so if the endoscopy were normal. If the presence of infection by Helicobacter pylori were unknown in a patient with gastroduodenal ulcer, 65.3% would treat with anti-H2 or proton pump inhibitors associated with a diagnostic test of infection by Helicobacter pylori. If the physician decided to carry out eradication treatment of Helicobacter pylori infection, 98.6% would use one of the regimes recommended by different scientific societies. If confirmation of eradication of Helicobacter pylori infection were requested, 89% would do so one and three months after completion of treatment. In patients with gastric ulcer, 69.3% would request endoscopy on completion of treatment. The percentage of physicians specialized in Family and Community Medicine who would carry out eradication treatment in patients with duodenal ulcer and Helicobacter pylori infection and who would request endoscopies in patients with dyspepsia was found to be statistically significant in comparison with physicians without this specialty. CONCLUSIONS: The attitude of primary care physicians in the metropolitan area of Barcelona with regard to the diagnosis and treatment of infection by Helicobacter pylori in gastroduodenal diseases largely reflects the recommendations recently made by several scientific societies. In general there are no significant differences with respect to this attitude in regard to the age and sex of the physician, although their training was found to influence in some of the responses analyzed.

Diagnostic value of duodenal antitissue transglutaminase antibodies in gluten-sensitive enteropathy.

BACKGROUND: In gluten-sensitive enteropathy, antitissue transglutaminase antibodies are synthesized in the duodenum. AIM: To compare the diagnostic yield of these autoantibodies in cultured duodenal biopsies, duodenal aspirate and serum. METHODS: Patients (n = 315, 135 female, 180 male; age: 37.3 +/- 1.1 years) referred for duodenal biopsies, were recruited and HLA-DQ2/DQ8 haplotyped. Histological measurements were made from duodenal biopsies and cultured duodenal biopsies were used for antitissue transglutaminase antibodies analysis by enzyme-linked immunosorbent assay. Duodenal aspirate was collected in a subgroup of 81 patients. Patients were classified, according to their histology, response to a gluten-free diet and DQ2/DQ8 status, as definite, likely or nongluten-sensitive enteropathy. RESULTS: Histology was normal in 59% of patients; 28% had lymphocytic enteritis, 1% had crypt hyperplasia and 13% showed atrophy. In Marsh III patients, there was complete agreement between duodenal and serological antitissue transglutaminase antibodies measurements. Marsh I patients showed a slight antitissue transglutaminase antibodies sensitivity improvement in cultured duodenal biopsy compared to serum in definite (22% vs. 19%) and likely gluten-sensitive enteropathy (20% vs. 14%) patients. Combined serum and cultured duodenal biopsy antitissue transglutaminase antibodies assessment increased serological sensitivity from 19% to 30% in Marsh I patients. CONCLUSION: Duodenal antitissue transglutaminase antibodies detection improves serological determination sensitivity in Marsh I patients, providing diagnostic value and therapeutic impact.

Spectrum of gluten-sensitive enteropathy in first-degree relatives of patients with coeliac disease: clinical relevance of lymphocytic enteritis.

BACKGROUND: Limited data on a short series of patients suggest that lymphocytic enteritis (classically considered as latent coeliac disease) may produce symptoms of malabsorption, although the true prevalence of this situation is unknown. Serological markers of coeliac disease are of little diagnostic value in identifying these patients. AIMS: To evaluate the usefulness of human leucocyte antigen-DQ2 genotyping followed by duodenal biopsy for the detection of gluten-sensitive enteropathy in first-degree relatives of patients with coeliac disease and to assess the clinical relevance of lymphocytic enteritis diagnosed with this screening strategy. PATIENTS AND METHODS: 221 first-degree relatives of 82 DQ2+ patients with coeliac disease were consecutively included. Duodenal biopsy (for histological examination and tissue transglutaminase antibody assay in culture supernatant) was carried out on all DQ2+ relatives. Clinical features, biochemical parameters and bone mineral density were recorded. RESULTS: 130 relatives (58.8%) were DQ2+, showing the following histological stages: 64 (49.2%) Marsh 0; 32 (24.6%) Marsh I; 1 (0.8%) Marsh II; 13 (10.0%) Marsh III; 15.4% refused the biopsy. 49 relatives showed gluten sensitive enteropathy, 46 with histological abnormalities and 3 with Marsh 0 but positive tissue transglutaminase antibody in culture supernatant. Only 17 of 221 relatives had positive serological markers. Differences in the diagnostic yield between the proposed strategy and serology were significant (22.2% v 7.2%, p<0.001). Relatives with Marsh I and Marsh II-III were more often symptomatic (56.3% and 53.8%, respectively) than relatives with normal mucosa (21.1%; p = 0.002). Marsh I relatives had more severe abdominal pain (p = 0.006), severe distension (p = 0.047) and anaemia (p = 0.038) than those with Marsh 0. The prevalence of abnormal bone mineral density was similar in relatives with Marsh I (37%) and Marsh III (44.4%). CONCLUSIONS: The high number of symptomatic patients with lymphocytic enteritis (Marsh I) supports the need for a strategy based on human leucocyte antigen-DQ2 genotyping followed by duodenal biopsy in relatives of patients with coeliac disease and modifies the current concept that villous atrophy is required to prescribe a gluten-free diet.

Randomized comparison of endoscopic microwave coagulation and endoscopic sclerosis in the treatment of bleeding peptic ulcers.

We conducted a prospective randomized trial to evaluate the effectiveness and safety of endoscopic microwave coagulation in comparison to endoscopic sclerosis in the treatment of peptic ulcer bleeding. Over 15 months 127 ulcer-bleeding patients with an actively bleeding vessel (N = 21), a non-bleeding vessel (N = 53), oozing hemorrhage (N = 25), or an adherent clot (N = 28) in the ulcer base were randomly assigned during endoscopy to receive treatment with endoscopic sclerosis or with microwave coagulation. There were no significant differences in effectiveness between endoscopic sclerosis and microwave coagulation in any of the assessed parameters: the percentage of patients with major recurrent hemorrhage (5 vs. 12), the percentage who needed emergency surgery (5 vs. 9), the mean (+/- SD) transfusion requirements (0.32 +/- 0.89 vs. 0.78 +/- 1.65), the mean number of hospital days (10.3 +/- 3.5 vs. 10.7 +/- 4.1), and the number of deaths due to bleeding (0 vs. 2) were similar in both groups. No case of perforation occurred in either group. The data suggest that microwave coagulation is as effective and safe as endoscopic sclerosis in the treatment of bleeding peptic ulcers.

Endoscopic sclerosis in the treatment of bleeding peptic ulcers with a visible vessel.

We have assessed the efficacy of endoscopic sclerosis in the routine clinical management of patients with bleeding ulcers, in whom a visible vessel was identified at endoscopy. Over a period of 14 months, a visible vessel at the base of an ulcer was identified in 53 patients. Three patients could not undergo sclerosis, one because of torrential bleeding and two because of ulcer location. Fifty patients, 18 with a bleeding vessel and 32 with a nonbleeding vessel, were subjected to endoscopic sclerosis with adrenaline plus polidocanol. Permanent hemostasis was achieved in 45 patients (90%), 31 (62%) cases with one session and 14 (28%) cases with two sessions of sclerosis. Four patients had persistent rebleeding in spite of two sessions of sclerosis, and one patient had a massive rebleeding after the first session; all underwent emergency surgery. We believe that endoscopic sclerosis has a primary role in the treatment of ulcer bleeding, particularly in those patients in whom a visible vessel is identified at endoscopy.

Impact of colloidal bismuth subnitrate in the eradication rates of Helicobacter pylori infection-associated duodenal ulcer using a short treatment regimen with omeprazole and clarithromycin: a randomized study.

UNLABELLED: Recent trials have shown that duodenal ulcers treated by H2-blockers heal faster if Helicobacter pylori is eradicated concurrently. OBJECTIVES: To evaluate the efficacy of a short treatment regimen in H. pylori eradication and ulcer healing and to assess the impact of colloidal bismuth subnitrate (CBS) in H. pylori eradication rate. METHODS: Sixty-one patients with H. pylori-associated duodenal ulcer were randomized in two short treatment groups. Group A patients (31) were given omeprazole 20 mg b.i.d. x 8 days. Clarithromycin (500 mg, b.i.d.) and CBS (120 mg, q.i.d.) were added 24 h after starting omeprazole and were given for 7 days. Group B patients (30) were treated as group A patients but without CBS. Endoscopies were performed at entry and 4 wk after the end of treatment. Presence of H. pylori was assessed at each endoscopy by urease test, and biopsy specimens were examined for histological evidence of gastritis and by Gram stain and culture for H. pylori infection. No patient received follow-up treatment. RESULTS: H. pylori eradication rates were achieved in 25/31 (80.6%) group A patients and in 15/30 (50%) in group B patients (p = 0.012). Duodenal ulcer healing was documented in 30/31 (96.8%) patients in group A and in 25/30 (83%) patients in group B. CONCLUSIONS: The addition of CBS to the double therapy with omeprazole and clarithromycin substantially improves the eradication rate of H. pylori. Short therapy with omeprazole 20 mg/b.i.d., clarithromycin 500 mg/b.i.d., and CBS 120 mg/q.i.d. is a safe, well tolerated combination that achieves a 80.6% eradication rate of H. pylori and duodenal ulcer healing rates as good as those achieved by omeprazole 20 mg/d when given for 4 wk.

Controlled trial of endoscopic sclerosis in bleeding peptic ulcers.

Of 113 patients in whom endoscopy revealed a bleeding gastric or duodenal ulcer 55 were randomly allocated to receive endoscopic sclerosis (ES) (injections of adrenaline/polidocanol) plus cimetidine while 58 received cimetidine alone as controls. 3 patients treated with ES (5.5%) compared with 25 controls (43.1%) had a major recurrent haemorrhage during their hospital stay. ES also led to significant reductions in the need for emergency surgery (3 vs 20 patients), transfusion requirements (mean 0.42 [SD 1.1] vs 2.7 (3.19) U), and the length of hospital stay (11.6 [5.1] vs 16.2 [11.3] days). ES as an adjunct to conventional medical treatment is an effective and safe emergency therapy for gastrointestinal bleeding due to peptic ulcer.

Chronic hepatitis B reactivation following infliximab therapy in Crohn's disease patients: need for primary prophylaxis.

BACKGROUND: There is little information about the effect of infliximab on the clinical course of liver disease in Crohn's disease patients with concomitant hepatitis B virus (HBV) infection. Theoretically, immunosuppression induced by infliximab will facilitate viral replication which could be followed by a flare or exacerbation of disease when therapy is discontinued. There are no specific recommendations on surveillance and treatment of HBV before infliximab infusion. Two cases of severe hepatic failure related to infliximab infusions have been described in patients with rheumatic diseases. PATIENTS AND METHODS: Hepatitis markers (C and B) and liver function tests were prospectively determined to 80 Crohn's disease patients requiring infliximab infusion in three hospitals in Spain. RESULTS: Three Crohn's disease patients with chronic HBV infection were identified. Two of the three patients with chronic HBV infection suffered severe reactivation of chronic hepatitis B after withdrawal of infliximab therapy and one died. A third patient, who was treated with lamivudine at the time of infliximab therapy, had no clinical or biochemical worsening of liver disease during or after therapy. From the remaining 80 patients, six received the hepatitis B vaccine. Three patients had antibodies to both hepatitis B surface antigen (anti-HBs) and hepatitis B core protein (anti-HBc) with normal aminotransferase levels, and one patient had positive anti-hepatitis C virus (HCV) antibodies, negative HCV RNA, and normal aminotransferase levels. Except for the patients with chronic HBV infection, no significant changes in hepatic function were detected. CONCLUSIONS: Patients with Crohn's disease who are candidates for infliximab therapy should be tested for hepatitis B serological markers before treatment and considered for prophylaxis of reactivation using antiviral therapy if positive.

Incidence of collagenous and lymphocytic colitis: a 5-year population-based study.

OBJECTIVE: The incidence of collagenous and lymphocytic colitis is not well known. We sought to assess the incidence of collagenous and lymphocytic colitis in a well-defined population during a 5-yr study period. METHODS: From January 1, 1993, to December 31, 1997, all new patients diagnosed with collagenous or lymphocytic colitis living in the catchment area of the Hospital Mutua de Terrassa (Barcelona, Spain) were identified. Since 1993 all patients with chronic diarrhea were referred for a diagnostic colonoscopy. Multiple biopsy sampling of the entire colon was performed when appearance of the colonic mucosa was grossly normal. RESULTS: Twenty-three cases of collagenous colitis and 37 of lymphocytic colitis were diagnosed. The female:male ratios were 4.75:1 and 2.7:1 for collagenous and lymphocytic colitis, respectively. The mean age at onset of symptoms was 53.4+/-3.2 (range, 29-82) yr for collagenous colitis, and 64.3+/-2.7 (range, 28-87) yr for lymphocytic colitis (p = 0.012). The mean annual incidence per 100,000 inhabitants based on the year of onset of symptoms was 1.1 (95% confidence interval [CI], 0.4-1.7) for collagenous colitis, and 3.1 (95% CI, 2.0-4.2) for lymphocytic colitis. A peak incidence was observed in older women in both diseases. A rate of microscopic colitis of 9.5 per 100 normal-looking colonoscopies performed in patients with chronic watery diarrhea was observed. Normal rectal biopsies were found in 43 % and 8% of patients with collagenous and lymphocytic colitis, respectively. CONCLUSIONS: The incidence of lymphocytic colitis is three times higher than that of collagenous colitis. Microscopic colitis should be considered as a major possibility in the work-up of chronic diarrhea in older women.