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. 1992 May;33(5):683–686. doi: 10.1136/gut.33.5.683

Non-steroidal anti-inflammatory drugs as a possible cause of collagenous colitis: a case-control study.

R H Riddell 1, M Tanaka 1, G Mazzoleni 1
PMCID: PMC1379302  PMID: 1612488

Abstract

The use of oral non-steroidal anti-inflammatory drugs (NSAIDs) in 31 patients with collagenous colitis and in 31 matched control patients with irritable bowel syndrome or colonic diverticular disease who had also undergone colonoscopy and biopsy was investigated. The long term use (greater than 6 months) of NSAIDs was significantly commoner in the study group (19/31) than in the control group (4/31) (p less than 0.02), even assuming the most adverse drug history in six patients in whom this could not be established. In all patients with collagenous colitis taking NSAIDs, diarrhoea followed the use of these drugs, and by a mean (SD) of 5.5 (4.4) years (range 0.5 to 15 years). In three patients with collagenous colitis, diarrhoea improved after withdrawing NSAIDs; rechallenge in one was followed by a recurrence of diarrhoea, which improved after withdrawing the drug again. It is suggested that NSAIDs may play an aetiological role in the diarrhoea and thickened collagen band in some patients with collagenous colitis.

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Selected References

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  1. Bjarnason I., Smethurst P., Fenn C. G., Lee C. E., Menzies I. S., Levi A. J. Misoprostol reduces indomethacin-induced changes in human small intestinal permeability. Dig Dis Sci. 1989 Mar;34(3):407–411. doi: 10.1007/BF01536263. [DOI] [PubMed] [Google Scholar]
  2. Bjarnason I., Williams P., Smethurst P., Peters T. J., Levi A. J. Effect of non-steroidal anti-inflammatory drugs and prostaglandins on the permeability of the human small intestine. Gut. 1986 Nov;27(11):1292–1297. doi: 10.1136/gut.27.11.1292. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bjarnason I., Williams P., So A., Zanelli G. D., Levi A. J., Gumpel J. M., Peters T. J., Ansell B. Intestinal permeability and inflammation in rheumatoid arthritis: effects of non-steroidal anti-inflammatory drugs. Lancet. 1984 Nov 24;2(8413):1171–1174. doi: 10.1016/s0140-6736(84)92739-9. [DOI] [PubMed] [Google Scholar]
  4. Bjarnason I., Zanelli G., Smith T., Prouse P., Williams P., Smethurst P., Delacey G., Gumpel M. J., Levi A. J. Nonsteroidal antiinflammatory drug-induced intestinal inflammation in humans. Gastroenterology. 1987 Sep;93(3):480–489. doi: 10.1016/0016-5085(87)90909-7. [DOI] [PubMed] [Google Scholar]
  5. Bo-Linn G. W., Vendrell D. D., Lee E., Fordtran J. S. An evaluation of the significance of microscopic colitis in patients with chronic diarrhea. J Clin Invest. 1985 May;75(5):1559–1569. doi: 10.1172/JCI111861. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Eckstein R. P., Dowsett J. F., Riley J. W. Collagenous enterocolitis: a case of collagenous colitis with involvement of the small intestine. Am J Gastroenterol. 1988 Jul;83(7):767–771. [PubMed] [Google Scholar]
  7. Esselinckx W., Brenard R., Colin J. F., Melange M. Juvenile scleroderma and collagenous colitis. The first case. J Rheumatol. 1989 Jun;16(6):834–836. [PubMed] [Google Scholar]
  8. Fang W. F., Broughton A., Jacobson E. D. Indomethacin-induced intestinal inflammation. Am J Dig Dis. 1977 Sep;22(9):749–760. doi: 10.1007/BF01694504. [DOI] [PubMed] [Google Scholar]
  9. Fausa O., Foerster A., Hovig T. Collagenous colitis. A clinical, histological, and ultrastructural study. Scand J Gastroenterol Suppl. 1985;107:8–23. doi: 10.3109/00365528509099747. [DOI] [PubMed] [Google Scholar]
  10. Giardiello F. M., Bayless T. M., Jessurun J., Hamilton S. R., Yardley J. H. Collagenous colitis: physiologic and histopathologic studies in seven patients. Ann Intern Med. 1987 Jan;106(1):46–49. doi: 10.7326/0003-4819-106-1-46. [DOI] [PubMed] [Google Scholar]
  11. Giardiello F. M., Bayless T. M., Yardley J. H. Collagenous colitis. Compr Ther. 1989 Feb;15(2):49–54. [PubMed] [Google Scholar]
  12. Giardiello F. M., Hansen F. C., 3rd, Lazenby A. J., Hellman D. B., Milligan F. D., Bayless T. M., Yardley J. H. Collagenous colitis in setting of nonsteroidal antiinflammatory drugs and antibiotics. Dig Dis Sci. 1990 Feb;35(2):257–260. doi: 10.1007/BF01536772. [DOI] [PubMed] [Google Scholar]
  13. Giardiello F. M., Lazenby A. J., Bayless T. M., Levine E. J., Bias W. B., Ladenson P. W., Hutcheon D. F., Derevjanik N. L., Yardley J. H. Lymphocytic (microscopic) colitis. Clinicopathologic study of 18 patients and comparison to collagenous colitis. Dig Dis Sci. 1989 Nov;34(11):1730–1738. doi: 10.1007/BF01540051. [DOI] [PubMed] [Google Scholar]
  14. Gledhill A., Cole F. M. Significance of basement membrane thickening in the human colon. Gut. 1984 Oct;25(10):1085–1088. doi: 10.1136/gut.25.10.1085. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Grouls V., Vogel J., Sorger M. Collagenous colitis. Endoscopy. 1982 Jan;14(1):31–33. doi: 10.1055/s-2007-1021570. [DOI] [PubMed] [Google Scholar]
  16. Hall R. I., Petty A. H., Cobden I., Lendrum R. Enteritis and colitis associated with mefenamic acid. Br Med J (Clin Res Ed) 1983 Oct 22;287(6400):1182–1182. doi: 10.1136/bmj.287.6400.1182. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Hwang W. S., Kelly J. K., Shaffer E. A., Hershfield N. B. Collagenous colitis: a disease of pericryptal fibroblast sheath? J Pathol. 1986 May;149(1):33–40. doi: 10.1002/path.1711490108. [DOI] [PubMed] [Google Scholar]
  18. Jessurun J., Yardley J. H., Giardiello F. M., Hamilton S. R., Bayless T. M. Chronic colitis with thickening of the subepithelial collagen layer (collagenous colitis): histopathologic findings in 15 patients. Hum Pathol. 1987 Aug;18(8):839–848. doi: 10.1016/s0046-8177(87)80059-x. [DOI] [PubMed] [Google Scholar]
  19. Lang J., Price A. B., Levi A. J., Burke M., Gumpel J. M., Bjarnason I. Diaphragm disease: pathology of disease of the small intestine induced by non-steroidal anti-inflammatory drugs. J Clin Pathol. 1988 May;41(5):516–526. doi: 10.1136/jcp.41.5.516. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Langman M. J., Morgan L., Worrall A. Use of anti-inflammatory drugs by patients admitted with small or large bowel perforations and haemorrhage. Br Med J (Clin Res Ed) 1985 Feb 2;290(6465):347–349. doi: 10.1136/bmj.290.6465.347. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Manning A. P., Thompson W. G., Heaton K. W., Morris A. F. Towards positive diagnosis of the irritable bowel. Br Med J. 1978 Sep 2;2(6138):653–654. doi: 10.1136/bmj.2.6138.653. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Nagaraj H. S., Sandhu A. S., Cook L. N., Buchino J. J., Groff D. B. Gastrointestinal perforation following indomethacin therapy in very low birth weight infants. J Pediatr Surg. 1981 Dec;16(6):1003–1007. doi: 10.1016/s0022-3468(81)80865-2. [DOI] [PubMed] [Google Scholar]
  23. Rams H., Rogers A. I., Ghandur-Mnaymneh L. Collagenous colitis. Ann Intern Med. 1987 Jan;106(1):108–113. doi: 10.7326/0003-4819-106-1-108. [DOI] [PubMed] [Google Scholar]
  24. Rask-Madsen J., Grove O., Hansen M. G., Bukhave K., Scient C., Henrik-Nielsen R. Colonic transport of water and electrolytes in a patient with secretory diarrhea due to collagenous colitis. Dig Dis Sci. 1983 Dec;28(12):1141–1146. doi: 10.1007/BF01295815. [DOI] [PubMed] [Google Scholar]
  25. Robert A. An intestinal disease produced experimentally by a prostaglandin deficiency. Gastroenterology. 1975 Oct;69(4):1045–1047. [PubMed] [Google Scholar]
  26. Rooney P. J., Jenkins R. T., Smith K. M., Coates G. 111Indium-labelled polymorphonuclear leucocyte scans in rheumatoid arthritis--an important clinical cause of false positive results. Br J Rheumatol. 1986 May;25(2):167–170. doi: 10.1093/rheumatology/25.2.167. [DOI] [PubMed] [Google Scholar]
  27. Segal A. W., Isenberg D. A., Hajirousou V., Tolfree S., Clark J., Snaith M. L. Preliminary evidence for gut involvement in the pathogenesis of rheumatoid arthritis? Br J Rheumatol. 1986 May;25(2):162–166. doi: 10.1093/rheumatology/25.2.162. [DOI] [PubMed] [Google Scholar]
  28. Sylwestrowicz T., Kelly J. K., Hwang W. S., Shaffer E. A. Collagenous colitis and microscopic colitis: the watery diarrhea-colitis syndrome. Am J Gastroenterol. 1989 Jul;84(7):763–768. [PubMed] [Google Scholar]
  29. Tanner A. R., Raghunath A. S. Colonic inflammation and nonsteroidal anti-inflammatory drug administration. An assessment of the frequency of the problem. Digestion. 1988;41(2):116–120. doi: 10.1159/000199740. [DOI] [PubMed] [Google Scholar]
  30. Wald A., Back C., Bayless T. M. Effect of caffeine on the human small intestine. Gastroenterology. 1976 Nov;71(5):738–742. [PubMed] [Google Scholar]
  31. Widgren S., Jlidi R., Cox J. N. Collagenous colitis: histologic, morphometric, immunohistochemical and ultrastructural studies. Report of 21 cases. Virchows Arch A Pathol Anat Histopathol. 1988;413(4):287–296. doi: 10.1007/BF00783020. [DOI] [PubMed] [Google Scholar]

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