Asunto(s)
Bloqueadores del Receptor Tipo 1 de Angiotensina II/efectos adversos , Esprue Colágeno/inducido químicamente , Olmesartán Medoxomilo/efectos adversos , Bloqueadores del Receptor Tipo 1 de Angiotensina II/administración & dosificación , Esprue Colágeno/diagnóstico por imagen , Esprue Colágeno/patología , Endoscopía del Sistema Digestivo , Femenino , Humanos , Olmesartán Medoxomilo/administración & dosificaciónRESUMEN
PURPOSE: Collagenous sprue (CS) is a rare enteropathy characterized by villous atrophy and a thickened subepithelial collagen band. The aim of this study is to describe the cross-sectional imaging findings of CS. METHODS: A case-control, retrospective study with cases of all CS patients from January 2000 to 2015 was performed. Inclusion criteria were (1) Histopathologic diagnosis and (2) Imaging with computed tomography abdomen/pelvis (CT A/P), CT enterography (CTE), or magnetic resonance enterography within 6 months of small bowel (SB) biopsy. Control subjects were irritable bowel syndrome (IBS) patients who underwent CTE. Imaging studies were examined by two GI radiologists, blinded to patient data. RESULTS: 108 patients (54 CS; 54 IBS) were included. Mean age was 56.7 ± 16.5 years, and 68% were female (72% in CS group vs. 63% in IBS group; p = 0.3). CS patients were significantly older (67 ± 12 vs. 47 ± 15 year; p < 0.001) and more likely to be on angiotensin receptor blockers (41% vs. 6%; p < 0.001) as compared to the IBS group. Compared to IBS, CS patients were more likely to have mesenteric lymph node (LN) prominence (56% vs. 15%; p < 0.001), jejunoileal fold pattern reversal (46% vs. 6%; p < 0.001), SB dilation (28% vs. 0%; p < 0.001), SB conformational change (28% vs. 6%; p = 0.002), SB wall thickening (13% vs. 2%; p = 0.03), and ulcerative jejunoileitis (4% vs. 0%; p = 0.01). Radiologists suspected malabsorption in 72% in the CS group and 2% in the IBS group (p < 0.001). CONCLUSION: Imaging findings suggestive of mucosal malabsorption are commonly demonstrated in CS.
Asunto(s)
Esprue Colágeno/diagnóstico por imagen , Estudios de Casos y Controles , Esprue Colágeno/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
Olmesartan, an angiotensin II receptor antagonist used to treat hypertension, is associated with few adverse effects. Here, a case of severe sprue-like enteropathy and acute kidney injury is described in a 68-year-old male taking olmesartan for 3-4 years. He presented to hospital with a five-week history of diarrhea, vomiting, and a 20 lb weight loss. Anti-TTG was negative with a normal IgA. Biopsies of the distal duodenum and duodenal cap revealed marked blunting of the villi with near complete villous atrophy of the biopsies from the bulb. There was an increase in intraepithelial lymphocytes as well as neutrophils in the surface epithelium. The patient's diarrhea improved upon discontinuation of olmesartan and he returned to his previous weight. Repeat endoscopy four months later demonstrated complete resolution of inflammatory change with normal villous architecture. Long-term olmesartan use is associated with severe sprue-like enteropathy. The mechanism of intestinal injury is unknown. Duodenal biopsy results may mimic other enteropathies such as celiac disease. Physicians should consider medications as potential etiologies of enteropathy.
Asunto(s)
Antihipertensivos/efectos adversos , Esprue Colágeno/patología , Diarrea/patología , Duodeno/patología , Imidazoles/efectos adversos , Tetrazoles/efectos adversos , Anciano , Atrofia , Biopsia , Esprue Colágeno/inducido químicamente , Diarrea/inducido químicamente , Humanos , Hipertensión/tratamiento farmacológico , Masculino , Vómitos/inducido químicamente , Vómitos/patología , Pérdida de PesoRESUMEN
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.
Asunto(s)
Anemia Ferropénica/diagnóstico , Colitis Colagenosa/diagnóstico , Colágeno/metabolismo , Esprue Colágeno/diagnóstico , Diarrea/diagnóstico , Enterocolitis/diagnóstico , Mucosa Intestinal/patología , Anemia Ferropénica/etiología , Biopsia , Colitis Colagenosa/complicaciones , Colitis Colagenosa/dietoterapia , Colitis Colagenosa/patología , Esprue Colágeno/complicaciones , Esprue Colágeno/dietoterapia , Esprue Colágeno/patología , Colon/patología , Diarrea/etiología , Dieta Sin Gluten , Duodeno/patología , Enterocolitis/complicaciones , Enterocolitis/dietoterapia , Enterocolitis/patología , Femenino , Humanos , Persona de Mediana EdadRESUMEN
We present a rare case of collagenous sprue in an elderly woman with significant weight loss and malnutrition. Collagenous sprue is a rare, female-predominant and immune-mediated gastrointestinal disease that can affect any part of the gut, and shares a strong association with Coeliac disease. The diagnosis is confirmed by gut histopathology demonstrating a subepithelial collagenous band and inflammatory infiltrate in the lamina propria. The pathogenesis and natural history is poorly elucidated, and treatment involves a gluten-free diet and/or immunomodulatory therapy.
Asunto(s)
Enfermedad Celíaca/diagnóstico , Esprue Colágeno/dietoterapia , Esprue Colágeno/patología , Pérdida de Peso , Anciano , Biopsia con Aguja , Enfermedad Celíaca/patología , Esprue Colágeno/diagnóstico , Diagnóstico Diferencial , Dieta Sin Gluten , Femenino , Estudios de Seguimiento , Humanos , Inmunohistoquímica , Mucosa Intestinal/patología , Medición de Riesgo , Resultado del TratamientoRESUMEN
Collagenous sprue is a clinicopathological entity with an unknown etiology. Its clinical features include progressive malabsorption, diarrhea, weight loss, unresponsiveness to treatment, and high mortality rates. The age interval of collagenous sprue is quite broad and ranges between 2 and 85 years. As far as to our knowledge, the presented case is the first reported case in infancy.
Asunto(s)
Enfermedad Celíaca/patología , Esprue Colágeno/patología , Intestino Delgado/patología , Enteropatías Perdedoras de Proteínas/patología , Enfermedad Celíaca/diagnóstico , Colágeno/metabolismo , Esprue Colágeno/diagnóstico , Humanos , Lactante , Masculino , Enteropatías Perdedoras de Proteínas/diagnósticoAsunto(s)
Mucosa Intestinal/ultraestructura , Síndromes de Malabsorción/clasificación , Microvellosidades/patología , Atrofia , Autoanticuerpos/sangre , Enfermedad Celíaca/diagnóstico , Enfermedad Crónica , Esprue Colágeno/diagnóstico , Esprue Colágeno/patología , Inmunodeficiencia Variable Común/diagnóstico , Inmunodeficiencia Variable Común/patología , Diagnóstico Diferencial , Diarrea/etiología , Duodeno/patología , Enteritis/diagnóstico , Enteritis/patología , Enterocitos/inmunología , Eosinofilia/diagnóstico , Eosinofilia/patología , Gastritis/diagnóstico , Gastritis/patología , Humanos , Imidazoles/efectos adversos , Síndromes de Malabsorción/inducido químicamente , Síndromes de Malabsorción/diagnóstico , Síndromes de Malabsorción/patología , Poliendocrinopatías Autoinmunes/diagnóstico , Poliendocrinopatías Autoinmunes/patología , Poliendocrinopatías Autoinmunes/fisiopatología , Tetrazoles/efectos adversosAsunto(s)
Enfermedad Celíaca/complicaciones , Enfermedad Celíaca/diagnóstico , Esprue Colágeno/diagnóstico , Esprue Colágeno/patología , Ciego/patología , Colon/patología , Endoscopía del Sistema Digestivo , Femenino , Mucosa Gástrica/patología , Histocitoquímica , Humanos , Mucosa Intestinal/patología , Microscopía , Persona de Mediana EdadRESUMEN
Collagenous sprue is a rare small bowel enteropathy that has overlapping clinical features with coeliac disease; it is commonly associated with arthritic autoimmune conditions, which often require non-steroidal anti-inflammatory drugs (NSAIDs). In the limited published literature available, there are putative suggestions of a link between NSAID use and collagen deposition in intestinal subepithelia in such patients. The authors present a case of a 43-year-old woman with long-standing NSAID use for autoimmune polyarthropathy and positive coeliac antibodies. However, distal duodenal biopsies revealed a thickened band of subepithelial collagen with villous atrophic appearances consistent with collagenous sprue. The patient was treated with a gluten-free diet and her NSAIDs were discontinued. After 6 months, her gastrointestinal symptoms had resolved with complete histological resolution of the collagenous subepithelial bands and villous atrophy on duodenal biopsy.