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DOI: 10.1055/s-2005-872611
© Georg Thieme Verlag Stuttgart · New York
Die mikroskopische Kolitis
Microscopic colitisPublication History
eingereicht: 7.3.2005
akzeptiert: 16.6.2005
Publication Date:
25 August 2005 (online)

Zusammenfassung
Unter dem Begriff mikroskopische Kolitis werden die histopathologischen Entitäten kollagene und lymphozytäre Kolitis zusammengefasst. Es handelt sich um eine Erkrankung letztlich unbekannter Ätiologie, die durch chronische, wässrige Diarrhöen bei unauffälligem endoskopischen Befund und eindeutiger Histologie gekennzeichnet ist. Das histologische Korrelat umfasst ein vermehrtes Infiltrat intraepithelialer Lymphozyten, den Nachweis oberflächlicher epithelialer Läsionen, ein mononukleäres Infiltrat der Lamina propria sowie nur bei der kollagenen Kolitis zusätzlich eine verdickte subepitheliale Kollagenschicht. Die mikroskopische Kolitis manifiestiert sich bevorzugt bei Frauen im 6. und 7. Lebensjahrzent. Vermutlich handelt es sich um unterschiedliche Manifestationsformen der gleichen Erkrankung, als Auslöser wird ein bislang nicht identifiziertes luminales Agens vermutet. Eine genetische Komponente wird durch familiäre Häufung nahegelegt, autoimmune Prozesse scheinen ebenfalls eine Rolle zu spielen. Auffällig ist die Assoziation mit verschiedenen gastrointestinalen, autoimmunen und rheumatischen Erkrankungen bei einem Teil der Patienten. Differenzialdiagnostisch sind Sprue und chronisch entzündliche Darmerkrankungen in der Regel eindeutig abgrenzbar. Da klinische, laborchemische und endoskopische Untersuchungen in der Regel unauffällig sind, ist die Diagnose ausschließlich histologisch zu sichern. Der chronisch-rezidivierende Verlauf der Erkrankung ist prinzipiell gutartig und häufig durch Spontanremissionen gekennzeichnet. Neben einer symptomatischen antidiarrhoischen Therapie kann der Einsatz von Bismuth-Subsalizylat und Budesonid zu anhaltenden Remissionen führen.
Summary
The term microscopic colitis comprises the histopathologic entities lymphocytic and collagenous colitis. The disease is characterized by watery diarrhea, normal endoscopic findings and a typical histology. Clinical laboratory and imaging results are usually normal. Histology shows typically superficial epithelial lesions of the mucosa, increased intraepithelial lymphocytes, a mononuclear infiltrate of the lamina propria and (only in case of collagenous colitis) a thickened subepithelial collagenous layer. Lymphocytic and collagenous colitis are considered as different manifestations of the same disease and predominantly affect women in their 5th to 7th decade. A singular cause has not been identified yet, presumably unindentified luminal antigens or autoimmune processes may play a role as well as a familial disposition. In differential diagnosis chronic inflammatory bowel disease and intestinal sprue should be considerded. The microspic colitides have a benign, chronically remitting course. Established therapy regimens consist of symptomatic anti-diarrheal therapy and use of bismuth-subsalicylate and budesonide.
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Prof. Dr. med. Christoph Pohl
Innere Abteilung, St. Elisabeth Krankenhaus
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