Volume 3, Issue 6, November 2015, Page: 238-244
Study the Efficacy of Budesonide Enema in Treating Collagenous Microscopic Colitis: An Egyptian Trial
Marwa Ahmed Saad Gouda, Internal Medicine Department, Geriatric Unit, Faculty of Medicine, Alexandria University, Alexandria, Egypt
Ahmed Ismail Al-lakani, Internal Medicine Department, Gastroenterology Unit, Faculty of Medicine, Alexandria University, Alexandria, Egypt
Magdy Mohammed Bedewy, Histo-Pathology Department, Military Academy Hospital, Alexandria, Egypt
Received: Oct. 27, 2015;       Accepted: Nov. 4, 2015;       Published: Nov. 17, 2015
DOI: 10.11648/j.ajim.20150306.14      View  4104      Downloads  55
Abstract
Chronic diarrhea can have a substantial impact on the patient’s quality of life and overall health. Microscopic colitis (MC) is an inflammatory bowel disease, which is characterized by chronic watery diarrhea. Many drugs, including steroids, had emerged to treat MC. Our aim was testing the efficacy of Budesonide enema in improvement of patients with collagenous microscopic colitis both clinically and histo-pathologiclly. 22 patients with active microscopic colitis were enrolled in the present study, 15 women, and 7 men, with mean age of 60.9±8.5 years. Mean duration of symptoms was 2.6±0.8 years. Patients were given Budesonide enema 2mg/100ml twice daily for 2 weeks then, once daily for 4 weeks. They were evaluated both clinically and histopathologically after 6 weeks.18 patients (81.8%) showed high statistically significant decrease in the thickness of collage layer, and degree of inflammation. The patients’ frequency of stool decreased from 7.6±1.0 to 2.7±1.6 motions/day (p<0.001), and also consistency of stool improved (p<0.001).We concluded that Budesonide enema in a dose of 2 mg/100ml was well tolerated and effective in induction of remission in active collagenous colitis. Effects on both clinical symptoms and inflammatory infiltrate were seen. Recurrence rate after stopping treatment is moderate. Non-responders may need prolonged duration of treatment or omitting the drugs that may be responsible for colonic inflammation.
Keywords
Chronic Diarrhea, Collagenous Colitis, Budesonide Enema
To cite this article
Marwa Ahmed Saad Gouda, Ahmed Ismail Al-lakani, Magdy Mohammed Bedewy, Study the Efficacy of Budesonide Enema in Treating Collagenous Microscopic Colitis: An Egyptian Trial, American Journal of Internal Medicine. Vol. 3, No. 6, 2015, pp. 238-244. doi: 10.11648/j.ajim.20150306.14
Copyright
Copyright © 2015 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Reference
[1]
Maev IV, Kucheryavyi YA, Andreev DN, Cheremushkin SV. Evolution of ideas on microscopic colitis. Ter Arkh 2015; 87(4): 69-76.
[2]
Freeman HJ, Weinstein WM, Shnitka TK, et al. Watery diarrhea syndrome associated with a lesion of the colonic basement membrane (CD)-lamina propria (LP) interface. Ann R Coll Phys Surg Can 1976; 9: 45.
[3]
Read N., Krejs G., Read M., Santa Ana C., Morawski S., Fordtran J.Chronic diarrhea of unknown origin. Gastroenterology 1980; 78: 264–71.
[4]
Lazenby A., Yardley J., Giardiello F., Jessurun J., Bayless T.Lymphocytic (“microscopic”) colitis: a comparative histopathologic study with particular reference to collagenous colitis. Hum Path 1989; 20: 18–28.
[5]
Williams, J.J., Kaplan, G.G., Makhija, S. et al. Microscopic colitis-defining incidence rates and risk factors: a population-based study. Clin Gastroenterol Hepatol 2008; 6: 35–40.
[6]
Pardi DS, Kelly CP. Microscopic Colitis .Gastroenterology 2011; 140 (4): 1155–65.
[7]
Pardi, D.S., Loftus, E.V. Jr, Smyrk, T.C. et al. The epidemiology of microscopic colitis: a population based study in Olmsted County, Minnesota. Gut 2007; 56: 504–8.
[8]
Harmsen W, et al. The epidemiology of microscopic colitis in Olmsted County from 2002 to 2010: a population-based study. Clin Gastroenterol Hepatol 2014; 12: 838–42.
[9]
Münch A., Aust D., Bohr J., Bonderup O., Fernandez-Banares F., Hjortswang H., et al.Microscopic colitis: current status, present and future challenges: statements of the European Microscopic Colitis Group. J Crohns Colitis 2012; 6: 932–45.
[10]
Jennifer J. Williams; Paul L. Beck; Christopher N. Andrews; David B. Hogan; Martin A. Storr. Microscopic Colitis — A Common Cause of Diarrhoea in Older Adults. Age Ageing 2010; 39(2): 162-8.
[11]
Olesen, M., Eriksson, S., Bohr, J. et al. Microscopic colitis: a common diarrheal disease (An epidemiological study in Orebro, Sweden, 1993–1998). Gut 2004; 53: 346–50.
[12]
Cindoruk M, Tuncer C, Dursun A, et al. Increased colonic intraepithelial lymphocytes in patients with Hashimoto's thyroiditis. J Clin Gastroenterol 2002; 34: 237–9.
[13]
Chan JL, Tersmette AC, Offerhaus GJ, Gruber SB, Bayless TM, Giardiello FM. Cancer risk in collagenous colitis. Inflamm Bowel Dis 1999; 5: 40–3.
[14]
Kaplan GG, Seminowich S, Williams J, et al. The risk of microscopic colitis in solid-organ transplantation patients: a population-based study. Transplantation 2008; 85: 48–54.
[15]
Fernandez-Banares F, Esteve M, Espinos JC, et al. Drug consumption and the risk of microscopic colitis. Am J Gastroenterol 2007; 102: 324–30.
[16]
Koskela RM, Karttunen TJ, Niemela SE, Lehtola JK, Ilonen J, Karttunen RA. Human leucocyte antigen and TNFalpha polymorphism association in microscopic colitis. Eur J Gastroenterol Hepatol 2008; 20: 276–82.
[17]
Cindoruk M, Tuncer C, Dursun A, et al. Increased colonic intraepithelial lymphocytes in patients with Hashimoto's thyroiditis. J Clin Gastroenterol 2002; 34: 237–9.
[18]
Ung KA, Gillberg R, Kilander A, Abrahamsson H. Role of bile acids and bile acid binding agents in patients with collagenous colitis. Gut 2000; 46: 170–5.
[19]
Perk G, Ackerman Z, Cohen P, Eliakim R. Lymphocytic colitis: a clue to an infectious trigger. Scand J Gastroenterol 1999; 34: 110–2.
[20]
Erim T, Alazmi WM, O'Loughlin CJ, Barkin JS. Collagenous colitis associated with Clostridium difficile: a cause effect? Dig Dis Sci 2003; 48: 1374–5.
[21]
Bonderup OK, Folkersen BH, Gjersoe P, Teglbjaerg PS. Collagenous colitis: a long-term follow-up study. Eur J Gastroenterol Hepatol 1999; 11: 493–5.
[22]
Chan JL, Tersmette AC, Offerhaus GJ, Gruber SB, Bayless TM, Giardiello FM. Cancer risk in collagenous colitis. Inflamm Bowel Dis 1999; 5: 40–3.
[23]
Bohr J, Tysk C, Eriksson S, Abrahamsson H, Jarnerot G. Collagenous colitis: a retrospective study of clinical presentation and treatment in 163 patients. Gut 1996; 39: 846–51.
[24]
Fine KD, Lee EL. Efficacy of open-label bismuth subsalicylate for the treatment of microscopic colitis. Gastroenterology 1998; 114: 29–36.
[25]
Vikram T, Nilesh Ch. Use of Budesonide in the Treatment of Microscopic Colitis. Saudi J Gastroentrol 2010; 16(3): 236-8.
[26]
Bonderup O., Hansen J., Teglbjaerg P., Christensen L., Fallingborg J.Long-term budesonide treatment of collagenous colitis: a randomised, double-blind, placebo-controlled trial. Gut 2009; 58: 68–72.
[27]
Stewart M., Seow C., Storr M.Prednisolone and budesonide for short- and long-term treatment of microscopic colitis: systematic review and meta-analysis. Clin Gastroenterol Hepatol 2011; 9: 881–90.
[28]
Miehlke S., Madisch A., Voss C., Morgner A., Heymer P., Kuhlisch E., et al.Long-term follow-up of collagenous colitis after induction of clinical remission with budesonide. Aliment Pharmacol Ther 2005; 22: 1115–9.
[29]
Miehlke S., Madisch A., Karimi D., Wonschik S., Kuhlisch E., Beckmann R., et al. Budesonide is effective in treating lymphocytic colitis: a randomized double-blind placebo-controlled study. Gastroenterology 2009; 136: 2092–100.
[30]
Gross V1, Bar-Meir S, Lavy A, Mickisch O, Tulassay Z, Pronai L, et al. International Budesonide Foam Study Group. Budesonide foam versus budesonide enema in active ulcerative proctitis and proctosigmoiditis. Aliment Pharmacol Ther. 2006; 15; 23(2): 303-12.
[31]
Gentile N., Khanna S., Loftus E., Jr, Smyrk T., Tremaine W., Harmsen W, et al.The epidemiology of microscopic colitis in Olmsted County from 2002 to 2010: a population-based study. Clin Gastroenterol Hepatol 2014; 12: 838–42.
[32]
Drossman D., Corazziari E., Talley N., Thompson W., Whitehead W., editors. (eds) Rome III: The Functional Gastrointestinal Disorders.2006 Third edition McLean, VA: Degnon.
[33]
Karatepe O., Altiok M., Battal M., Kamali G., Kemik A., Aydin T., et al. The effect of progesterone in the prevention of the chemically induced experimental colitis in rats. Acta Cir Bras 2012; 27: 23–9.
[34]
Pardi D., Kelly C.Microscopic colitis. Gastroenterology 2011; 140: 1155–65.
[35]
Beaugerie L., Pardi D. Review article: drug-induced microscopic colitis – proposal for a scoring system and review of the literature. Aliment Pharmacol Ther 2005; 22: 277–84.
[36]
Pardi D., Ramnath V., Loftus E., Jr, Tremaine W., Sandborn W. Lymphocytic colitis: clinical features, treatment, and outcomes. Am J Gastroenterol 2002; 97: 2829–33.
[37]
Roth B., Manjer J., Ohlsson B. Microscopic colitis is associated with several concomitant diseases. DTI 2013; 7: 19–25.
[38]
Papadakis K., Targan S. Role of cytokines in the pathogenesis of inflammatory bowel disease. Ann Rev Med 2000; 51: 289–98.
[39]
Hanauer S. Inflammatory bowel disease: epidemiology, pathogenesis, and therapeutic opportunities. Inflamm Bowel Dis 2006; 12(Suppl. 1): S3–S9.
[40]
Burakoff R.Indeterminate colitis: clinical spectrum of disease. J Clin Gastroenterol 2004; 38: S41-S3.
[41]
Fernandez-Banares, F., Salas, A., Esteve, M. et al. Collagenous and lymphocytic colitis (evaluation of clinical and histological features, response to treatment, and long-term follow–up). Am J Gastroenterol 2003; 98: 340–7.
[42]
Travis S., Stange E., Lemann M., Oresland T., Chowers Y., Forbes A., et al. European evidence based consensus on the diagnosis and management of Crohn’s disease: Current management. Gut 2006; 55(Suppl.): i16-i35.
[43]
Girlich C., Scholmerich J. Topical delivery of steroids in inflammatory bowel disease. Curr Drug Deliv 2012; 9: 345–9.
[44]
De Cassan C, Fiorino G, Danese S. Second-generation corticosteroids for the treatment of Crohn's disease and ulcerative colitis: more effective and less side effects?Dig Dis. 2012; 30(4): 368-75.
[45]
Nunes T, Barreiro-de Acosta M, Marin-Jiménez I, Nos P, Sans M. Oral locally active steroids in inflammatory bowel disease. J Crohns Colitis 2013 Apr; 7(3): 183-91.
[46]
Goff JS, Barnett JL, Pelke T, et al. Collagenous colitis: Histopathology and clinical course. Am J Gastroenterol 1997; 92: 57–60.
[47]
Bonderup OK, Hansen JB, Fallingborg J, et al.Budesonide treatment of collagenous colitis: a randomized, double blind, placebo controlled trial with morphometric analysis. GUT 2003; 52 (2): 248-51.
[48]
Lee E, Schiller LR, Vendrell D, et al. Subepithelial collagen table thickness in colon specimens from patients with microscopic colitis and collagenous colitis. Gastroenterology 1992; 103: 1790–6.
[49]
Stephen B, Malcolm R, Ronald P, Audrey J, Tore P, Lars-Goran N, Karen WB, Lloyd, Jeffrey G.Budesonide Enema for the Treatment of Active, Distal UlcerativeColitis and Proctitis: A Dose-Ranging Study.Gastroenterology 1998; 115: 525–32.
[50]
Lindgren, R. Löfberg, L. Bergholm, M. Hellblom, L. Carling, K.-A. Ung, R. Schiöler, P. Unge, C. Wallin, M. Ström, T. Persson & O. B. Suhr.Effect of Budesonide Enema on Remission and Relapse Rate in Distal Ulcerative Colitis and Proctitis.Scandinavian Journal of Gastroenterology 2002, 37 (6): 705-10.
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