Microscopic colitis of incomplete collagen type in combination with lactase deficiency

The  number   of  patients  complaining   of  indigestion  is  increasing   every  year.  Made  a  significant   contribution  to  this the COVID-19 pandemic, which has been  going on for almost  3 years, led to this, the drugs used to treat  the infection  and its complications have  a negative  effect  on the  gastrointestinal tract, not  to mention  the  most  damaging  effect  of the  virus. Against  the  backdrop  of an increasing  number  of patients with indigestion as a result  of COVID-19, it is important not  to forget  about  other  diseases  that  do not lie on the surface  and do not always have typical manifestations. A relatively young disease, but increasingly common among patients with diarrhea, is microscopic colitis (MC). This article presents a clinical case of microscopic colitis of incomplete collagen  type in combination with lactase  deficiency. MC is a chronic inflammatory bowel disease  of unknown  etiology, characterized by chronic watery diarrhea,  the  absence of macroscopic  signs  of colon  damage in the presence of specific pathomorphological changes. Based on the histological result, two main forms are distinguished: collagenous and lymphocytic colitis. According to the latest  data presented in the European guidelines, the overall prevalence of MC is 119.4 cases  per 100 thousand people,  and the  incidence  is 11.4 cases  per 100 thousand population per year. The progressive  increase  in the  incidence,  and even  the  prevalence of MC over patients with inflammatory  bowel  disease  (IBD) in some countries  in the group over 60 years of age, has led to an increase  in clinical interest in this problem, improvement of diagnostic  methods and revision of clinical guidelines in February 2021. Given the increase  in the incidence  of MC, the difficult diagnostic  search  for this  diagnosis,  age  variation, and  the  description of clinical  cases  that  differ from the  average portraits  of a “typical patient” with microscopic colitis are of clinical interest.

1. Lindström CG. Collagenous colitis’ with watery diarrhea – a new entity? Pathol Eur. 1976;11(1):87–89. Available at: https://pubmed.ncbi.nlm.nih.gov/934705.

2. Münch A, Aust D, Bohr J, Bonderup O, Fernández Bañares 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(9):932–945. https://doi.org/10.1016/j.crohns.2012.05.014.

3. Nielsen OH, Fernandez-Banares F, Sato T, Pardi DS. Microscopic colitis: Etiopathology, diagnosis, and rational management. Elife. 2022;11:e79397. https://doi.org/10.7554/eLife.79397.

4. Miehlke S, Guagnozzi D, Zabana Y, Tontini GE, Kanstrup Fiehn A-M, Wildt S et al. European guidelines on microscopic colitis: United European Gastroenterology and European Microscopic Colitis Group statements and recommendations. United European Gastroenterol J. 2021;9(1):13–37. https://doi.org/10.1177/2050640620951905.

5. El-Matary W, Girgis S, Huynh H, Turner J, Diederichs B. Microscopic colitis in children. Dig Dis Sci. 2010;55(7):1996–2001. https://doi.org/10.1007/s10620-009-0964-4.

6. Tome J, Kamboj AK, Pardi DS. Microscopic Colitis: A Concise Review for Clinicians. Mayo Clin Proc. 2021;96(5):1302–1308. https://doi.org/10.1016/j.mayocp.2021.03.022.

7. Fadeeva NA, Osadchuk AM, Kukoleva EO, Artykova GB, Khomeriki SG, Loranskaya ID, Parfenov AI. The Problems of Diagnosis and Treatment the Comorbidity of Celiac Disease and Miscroscopic Colitis. Effective Pharmacotherapy. 2022;18(22):112–116. (In Russ.) https://doi.org/10.33978/2307-3586-2022-18-22-112-116.

8. Mearin F, Lacy BE, Chang L, Chey WD, Lembo AJ, Simren M, Spiller R. Bowel Disorders. Gastroenterology. 2016;S0016-5085(16)00222-5. https://doi.org/10.1053/j.gastro.2016.02.031.

9. Miehlke S, Barreiro-de Acosta M, Bouma G, Carpio D, Magro F, Moreels T, Probert C. Oral budesonide in gastrointestinal and liver disease: A practical guide for the clinician. J Gastroenterol Hepatol. 2018. Available at: https://pubmed.ncbi.nlm.nih.gov/29603368.

10. Miehlke S, Heymer P, Bethke B, Bästlein E, Meier E, Bartram H-P et al. Budesonide treatment for collagenous colitis: a randomized, double-blind, placebo-controlled, multicenter trial. Gastroenterology. 2002;123(4):978–984. https://doi.org/10.1053/gast.2002.36042.

11. Bonderup OK, Hansen JB, Birket-Smith L, Vestergaard V, Teglbjaerg PS, Fallingborg J. Budesonide treatment of collagenous colitis: a randomised, double blind, placebo controlled trial with morphometric analysis. Gut. 2003;52(2):248–251. https://doi.org/10.1136/gut.52.2.248.

12. Andreev DN, Maev IV, Kucheryavyy YA, Cheremushkin SV. Microscopic colitis from the standpoint of modern gastroenterology. Consilium Medicum. 2021;23(5):395–401. (In Russ.) https://doi.org/10.26442/20751753.2021.5.200888.

13. Kulygina YuA, Skalinskaya MI, Ageeva TA. Microscopic colitis: the clinical case. Experimental and Clinical Gastroenterology. 2015;(3):101–105. (In Russ.) Available at: https://www.elibrary.ru/tquuwh.

14. Khalili H, Axelrad JE, Roelstraete B, Olén O, D’Amato M, Ludvigsson JF. Gastrointestinal Infection and Risk of Microscopic Colitis: A Nationwide Case-Control Study in Sweden. Gastroenterology. 2021;160(5):1599–1607. https://doi.org/10.1053/j.gastro.2021.01.004.

15. Cañas CA. The triggering of post-COVID-19 autoimmunity phenomena could be associated with both transient immunosuppression and an inappropriate form of immune reconstitution in susceptible individuals. Med Hypotheses. 2020;145:110345. https://doi.org/10.1016/j.mehy.2020.110345.