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Familial occurrence of microscopic colitis: a report on five families
Örebro Medical Centre Hospital.
University Hospital, Lund.
Ryhov Central Hospital, Jönköping.
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2001 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, Vol. 36, no 9, 959-962 p.Article in journal (Refereed) Published
Abstract [en]

Background: The etiology and pathogenesis of microscopic colitis is unknown. Whether genetic predisposition is of importance, as in many other gastrointestinal diseases, is unknown. Familial occurrence of collagenous colitis has earlier been reported only in two families.

Methods: Familial occurrence of microscopic colitis was searched for in a Swedish national microscopic colitis register.

Results: Familial occurrence of microscopic colitis was identified in five families. In all families a sister- sister relationship was found. Two sisters with collagenous colitis had been living apart in different Nordic countries for many years before developing the disease. In one pair, the smoking sister had collagenous colitis and the never smoking sister had lymphocytic colitis.

Conclusions: Considering the relative rarity of microscopic colitis, these findings indicate that a genetic predisposition may be of importance.

Place, publisher, year, edition, pages
2001. Vol. 36, no 9, 959-962 p.
Keyword [en]
collagenous colitis; familiar occurrence; genetic predisposition; lymphocytic colitis; microscopic colitis
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-84919DOI: 10.1080/00365520120415PubMedID: 11521987OAI: diva2:562922
Available from: 2012-10-26 Created: 2012-10-26 Last updated: 2012-10-31Bibliographically approved
In thesis
1. Microscopic colitis: studies of epidemiology, clinical features and nitric oxide
Open this publication in new window or tab >>Microscopic colitis: studies of epidemiology, clinical features and nitric oxide
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Lymphocytic colitis (LC) and collagenous colitis (CC) arc newly recognised inflammatory bowel diseases belonging to the group of microscopic colitides (MC). They are characterised clinically by chronic non-bloody and watery diarrhoea, and a macroscopically normal or near normal colonic mucosa where diagnostic histopathological abnormalities are found.

The aims of this thesis were to study the epidemiology of LC and CC in Örebro, the clinical features and outcome of treatment in a large Swedish cohort of patients with LC and the familial occurrence of MC. Further objectives were to study luminal levels of colonic nitric oxide (NO), plasma concentrations of the metabolites nitrate/nitrite and the epithelial expression of inducible nitric oxide synthase (iNOS) and endothelial nitric oxide synthase (eNOS) in patients with MC and correlate to clinical and histopathological status.

Whereas previously thought to be rare diseases, our epidemiological study in Örebro 1993- 1998 showed that the annual incidence of LC and CC is close to the figures generally reported in Sweden in Crohn's disease. The combined rates of LC and CC are nearly as high as the incidence of ulcerative colitis. Microscopic colitis was diagnosed in 10% of all patients referred for a colonoscopy due to non-bloody diarrhoea, and in almost 20% of those older than 70 years.

The clinical features and outcome of treatment in LC were studied retrospectively in 199 Swedish patients. Diarrhoea was the predominant symptom, followed by abdominal pain and weight loss. Forty percent had at least one associated autoimmune or inflammatory disease; the most common were thyroid disorder and coeliac disease. A single attack occurred in 63% with a median disease duration of six months. In 1 0% a drug induced disease was suspected. A sudden onset of disease was noted in 25% and a non-significant peak of disease onset was seen in December-Janumy. The sudden onset, the single attack of limited duration, and the possible seasonality of the disease's onset may indicate an infectious etiology in some cases.

Corticosteroids, prednisolone as well as budesonide, were the most effective therapy in our retrospective LC study and more than 80% of the patients improved short-term. However, the relapse risk was high after withdrawal of therapy. A response rate of 50-70% was noted for loperamide, cholestyramine, metronidazole and mesalazine.

A family history of bowel disease- ulcerative colitis, Crohn's disease, CC or coeliac diseasewas reported in 12% of the 199 LC patients, and ulcerative colitis or Crohn's disease alone in 7%. We also report a familial occurrence of MC in five families, with two affected members in each family. In two families the members had different types of MC whereas in three families they all had CC.

Increased plasma levels of nitrate/nitrite and greatly enhanced levels of colonic luminal NO were found in MC patients. The NO levels were associated to the histopathological status and correlated with the clinical activity, indicating that NO is involved in the pathophysiology of MC. Expression of eN OS in the epithelium was not increased in patients with MC. An increased expression of iNOS was seen apically in the surface epithelium in MC patients, and a correlation between the staining intensity of iNOS and luminal NO levels, pointing towards the epithelial cells being the cellular source of the NO production.

Place, publisher, year, edition, pages
Linköpin: Linköping Universitet, 2004. 37 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 830
National Category
Medical and Health Sciences
urn:nbn:se:liu:diva-24731 (URN)6982 (Local ID)91-7373-800-X (ISBN)6982 (Archive number)6982 (OAI)
Public defence
2004-01-23, Wilandersalen, Universitetssjukhuset, Örebro, 09:00 (Swedish)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2012-10-26Bibliographically approved

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