Specific forms of chronic colitis

Collagen colitis

Collagen colitis is an inflammatory disease of the large intestine, characterized by intensive development of collagen in the mucous membrane.

Women are more often affected (10 times more often than men), mainly at the age of 45-55 years. The etiology of the disease is unknown. The immune-inflammatory process is important in the pathogenesis.

The main symptoms of the disease are diarrhea, pain, mainly in the right part of the colon (the rectum may not be involved in the inflammatory process). Endoscopically, a picture of inflammation of the mucous membrane of the colon is revealed.

The leading role in establishing a diagnosis belongs to the examination of the biopsy. The biopsy reveals a wide continuous band of collagen 10-15 μm or more in length under the interglandular surface of the epithelium. Also characteristic is an increase in the number of monocytes, lymphocytes, mast cells, plasma cells and eosinophils in the lamina propria and an increase in the number of interepithelial lymphocytes in the superficial epithelium. There are reports of the development of Crohn's disease in patients with collagenous colitis. Cases of ulcerative colitis following collagenous colitis have been described.

Eosinophilic enterocolitis (or gastroenteritis)

Eosinophilic enterocolitis (or gastroenteritis) is a manifestation of a type I allergic reaction to a food allergen, which is not always possible to determine. People aged 30-45 years are most often affected. The stomach and small intestine are mainly affected, sometimes the large intestine, most often the cecum. The main clinical symptoms are: nausea, vomiting, diarrhea, abdominal pain, and blood in the stool may be detected.

In biopsies of the mucous membrane of the affected organs, a picture of inflammation is observed, which can even be transmural, which brings this disease closer to Crohn's disease. In addition, pronounced eosinophilic infiltration is extremely characteristic. Unlike Crohn's disease, ulcers and granulomas are not observed in eosinophilic colitis. A characteristic sign is eosinophilia.

Lymphocytic colitis

Lymphocytic colitis is an inflammatory disease of the large intestine, characterized by lymphatic infiltration of the mucous membrane.

The etiology of the disease is unknown, men and women are equally affected. Clinical manifestations are the same as in collagenous colitis. A characteristic feature of the disease is pronounced mononuclear inflammatory infiltration of the lamina propria of the mucous membrane, as well as diffuse infiltration of both the superficial epithelium and the crypt epithelium with a large number of interepithelial lymphocytes and neutrophils. In the normal mucous membrane of the colon, there are less than 5 interepithelial lymphocytes per 100 cells of the superficial epithelium. In lymphocytic colitis, the number of interepithelial lymphocytes is 15-20 per 100 cells of the superficial epithelium and more, in all other inflammatory processes no more than 10.

Chronic colitis in diverticular disease

Chronic colitis in diverticular disease is an inflammatory process in the sigmoid colon affected by diverticular disease.

The disease occurs in elderly people. Patients complain of bloody stool, pain in the left iliac region in the projection of the sigmoid colon. Palpation of the abdomen reveals pain in the sigmoid colon. Rectosigmoidoscopy reveals confluent or focal granularity and friability of the mucous membrane of the sigmoid colon, most pronounced around the mouth of the diverticulum. Proximally and distally to the sigmoid colon, the mucous membrane of the colon is unchanged. Histological examination may reveal signs of Crohn's disease, which does not exclude the simultaneous coexistence of the two diseases.

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