Mikroskopische Kolitis – neue praxisrelevante Erkenntnisse

Zusammenfassung

Die mikroskopische Kolitis ist eine zunehmend häufig diagnostizierte, chronisch-entzündliche Darmerkrankung, die nahezu regelhaft mit wässriger, nicht blutiger Diarrhö einhergeht und darüber hinaus zu Bauchschmerzen, nächtlicher Diarrhö, imperativem Stuhldrang und Inkontinenz führen kann. Histologisch werden traditionell die kollagene und die lymphozytäre Kolitis unterschieden. Eine neue dritte Subgruppe ist die sog. inkomplette mikroskopische Kolitis, die sich klinisch nicht von den anderen Formen unterscheidet. Budesonid ist derzeit die einzige evidenzbasierte, effektive Therapie, allerdings sind viele Probleme im therapeutischen Langzeitmangement noch ungelöst. Die vorliegende Arbeit gibt einen aktuellen Überblick über neue, praxisrelevante Entwicklungen auf dem Gebiet der mikroskopischen Kolitis.

Abstract

Microscopic colitis is an increasingly recognised chronic inflammatory bowel disease associated with watery, non-bloody diarrhoea. In addition, many patients suffer from abdominal pain, nocturnal diarrhoea, urgency and incontinence. The two traditional histological subtypes are collagenous colitis and lymphocytic colitis. A novel third subgroup is the so-called incomplete microscopic colitis which is clinically indistinguishable. At present, budesonide is the only evidenced-based effective therapy, however many problems in the long-term treatment strategy are still unsolved. The present paper reviews new developments in microscopic colitis which are relevant for clinical practice.

Schlüsselwörter

kollagene Kolitis - chronisch-entzündliche Darmerkrankung - colon irritabile

Key words

collagenous colitis - chronic inflammatory bowel disease - irritable colon

• Literatur

• 1 Münch A, Aust D, Bohr J et al. Microscopic Colitis: current status, present and future challenges – Statements of the European Microscopic Colitis Group. J Crohn’s Colitis 2012; 6: 932-945
• 2 Pardi DS, Kelly CP. Microscopic colitis. Gastroenterology 2011; 140: 1155-1165
• 3 Stewart M, Andrews CN, Urbanskià S et al. The association of coeliac disease and microscopic colitis: a large population-based study. Aliment Pharmacol Ther 2011; 33: 1340-1349
• 4 Wigh T, Fenger GM, Lauge NG et al. Epidemiology of microscopic colitis: a 10-year nationwide Danish cohort study. J Crohn’s Colitis 2013; 7 (Suppl. 01) S268
• 5 Bjørnbak C, Engel PJH, Nielsen PL et al. Microscopic colitis: clinical findings, topography and persistence of histopathological subgroups. Aliment Pharmacol Ther 2011; 34: 1225-1234
• 6 Aust DE. Histopathology of microscopic colitis. Pathologe 2012; 33 (Suppl. 02) 221-224
• 7 Aust D, Münch A, Olesen M et al. Topographical distribution of collagenous colitis – a pooled histological analysis of 2 European prospective multicenter trials. Gastroenterology 2013; 144 (Suppl. 01) S421
• 8 Madisch A, Miehlke S, Bartosch F et al. Collagenous colitis: Clinical presentation, treatment and outcome of 287 patients. Gastroenterology 2008; 134: A620
• 9 Madisch A, Miehlke S, Kusnik B et al. Lymphocytic colitis: Clinical presentation, treatment and outcome of 207 patients. Gut 2007; 56: A128
• 10 Abboud R, Pardi DS, Tremaine WJ et al. Symptomatic overlap between microscopic colitis and irritable bowel syndrome: a prospective study. Inflamm Bowel Dis 2013; 19: 550-553
• 11 Wildt S, Nordgaard-Lassen I, Bendtsen F et al. Metabolic and inflammatory faecal markers in collagenous colitis. Eur J Gastroenterol Hepatol 2007; 19: 567-574
• 12 Yen EF, Pokhrel B, Bianchi LK et al. Decreased colorectal cancer and adenoma risk in patients with microscopic colitis. Dig Dis Sci 2012; 57: 161-169
• 13 Madisch A, Heymer P, Voss C et al. Oral Budesonide therapy improves quality of life in patients with collagenous colitis. Int J Colorect Dis 2005; 20: 312-316
• 14 Hjortswang H, Tysk C, Bohr J et al. Health related quality of life is impaired in active collagenous colitis. Dig Liv Dis 2011; 43: 102-109
• 15 Hjortswang C, Tysk C, Bohr J et al. Defining clinical criteria for clinical remission and disease activity in collagenous colitis. Inflamm Bowel Dis 2009; 15: 1875-1881
• 16 Pardi D. Microscopic Colitis: The American Perspective. In: Miehlke S, Münch A, (eds) Microscopic Colitis – Creating Awareness for an Underestimated Disease. Basel: Falk Workshop; 2012: 69-73
• 17 Tagkalidis PP, Gibson PR, Bhathal PS. Microscopic colitis demonstrates a T helper cell type 1 mucosal cytokine profile. J Clin Pathol 2007; 60: 382-387
• 18 Kumawat AK, Strid H, Tysk C et al. Microscopic colitis patients demonstrate a mixed Th17 / Tc17 and Th1 / Tc1 mucosal cytokine profile. Mol Immunol 2013; 55: 355-364
• 19 Kumawat AK, Strid H, Elgbratt K et al. Microscopic colitis patients have increased proportions of Ki67+ proliferating and CD45RO+ active/memory CD8+ and CD4+8+ mucosal T cells. J Crohn’s Colitis 2013; 7: 694-705
• 20 Göranzon C, Kumawat AK, Hultgren-Hörnqvist E et al. Immunohistochemical characterization of lymphocytes in microscopic colitis. J Crohns Colitis 2013; pii: S1873-9946(13)00072-X. doi 10.1016/j.crohns 2013.02.007. [Epub ahead of print]
• 21 Järnerot G, Tysk C, Bohr J et al. Collagenous colitis and fecal stream diversion. Gastroenterology 1995; 109: 449-455
• 22 Münch A, Söderholm JD, Wallon C et al. Dynamics of mucosal permeability and inflammation in collagenous colitis before, during, and after loop ileostomy. Gut 2005; 54: 1126-1128
• 23 Sapp H, Ithamukkala S, Brien TP et al. The terminal ileum is affected in patients with lymphocytic or collagenous colitis. Am J Surg Pathol 2002; 26: 1484-1492
• 24 Ayata G, Ithamukkala S, Sapp H et al. Prevalence and significance of inflammatory bowel disease-like morphologic features in collagenous and lymphocytic colitis. Am J Surg Pathol 2002; 26: 1414-1423
• 25 Vigren L, Sjöberg K, Benoni C et al. Is smoking a risk factor for collagenous colitis?. Scand J Gastroenterol 2011; 46: 1334-1339
• 26 Yen EF, Pokhrel B, Du H et al. Current and past cigarette smoking significantly increase risk for microscopic colitis. Inflamm Bowel Dis 2012; 18: 1835-1841
• 27 Fernández-Bañares F, de Sousa MR, Salas A et al. Epidemiological risk factors in microscopic colitis: a prospective case-control study. Inflamm Bowel Dis 2013; 19: 411-417
• 28 Fernández-Bañares F, de Sousa MR, Salas A et al. Impact of Current Smoking on the Clinical Course of Microscopic Colitis. Inflamm Bowel Dis 2013; [Epub ahead of print]
• 29 Baert F, Schmit A, D’Haens G et al. Budesonide in collagenous colitis: a double-blind placebo-controlled trial with histologic follow-up. Gastroenterology 2002; 122: 20-25
• 30 Miehlke S, Heymer P, Bethke B et al. Budenoside treatment for collagenous colitis – a randomized, double-blind, placebo-controlled, multicenter trial. Gastroenterology 2002; 123: 978-984
• 31 Bonderup OK, Hansen JB, Birket-Smith L et al. Budesonide treatment of collagenous colitis: a randomised, double-blind, placebo controlled trial with morpho-metric analysis. Gut 2003; 52: 248-251
• 32 Miehlke S, Madisch A, Kupcinskas L et al. Double-blind, Randomised, Placebo-controlled, Multicenter Study on Budesonide and Mesalazine in Collagenous Colitis (BUC-60/COC). Gastroenterology 2012; 142 (Suppl. 01) A1158
• 33 Miehlke S, Madisch A, Karimi D et al. Budesonide is effective in treating lymphocytic colitis: a randomized double-blind placebo-controlled study. Gastroenterology 2009; 136: 2092-2100
• 34 Pardi DS, Loftus Jr EV, Tremaine WJ et al. A randomized double-blind, placebo controlled trial of budesonide for the treatment of active lymphocytic colitis. Gastroenterol 2009; 136 (Suppl. 01) T 1193
• 35 Stewart MJ, Seow CH, Storr MA. Prednisolone and budesonide for short- and long-term treatment of microscopic colitis: systematic review and meta-analysis. Clin Gastroenterol Hepatol 2011; 9: 881-890
• 36 Miehlke S, Madisch A, Bethke B et al. Oral budesonide for maintenance treatment of collagenous colitis: a randomized, double-blind, placebo-controlled trial. Gastroenterology 2008; 135: 1510-1516
• 37 Bonderup OK, Hansen JB, Teglbjaerg PS et al. Long-term budesonide treatment of collagenous colitis – a randomised, double-blind, placebo-controlled trial. Gut 2009; 58: 68-72
• 38 Miehlke S, Hansen JB, Madisch A et al. Risk factors for Symptom Relapse in Collagenous Colitis after withdrawal of Short-Term Budesonide Therapy. Inflamm Bowel Dis 2013; in press
• 39 Chande N, McDonald JWD, MacDonald JK. Interventions for treating collagenous colitis. Cochrane Database of Systematic Reviews 2008; (02) Art. No.: CD003575.
• 40 Pardi DS, Loftus Jr EV, Tremaine WJ et al. Treatment of refractory microscopic colitis with azathioprine and 6-mercaptopurine. Gastroenterology 2001; 120: 1483-1484
• 41 Münch A, Fernandez-Banares F, Munck LK. Azathioprine and mercaptopurine in the management of patients with chronic, active microscopic colitis. Aliment Pharmacol Ther 2013; 37: 795-798
• 42 Esteve M, Mahadevan U, Sainz E et al. Efficacy of anti-TNF therapies in refractory severe microscopic colitis. J Crohns Colitis 2011; 5: 612-618
• 43 Münch A, Ignatova S, Strom M. Adalimumab in budesonide and methotrexate refractory collagenous colitis. Scand J Gastroenterol 2012; 47: 59-63
• 44 Münch A, Bohr J, Benoni C et al. Budesonide induces clinical remission and improves quality of life in active collagenos colitis: results from the open-label induction phase of BUC-63/COC. J Crohn Colitis 2013; 7: S238