collagenous colitis


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  • Clinical

    • mean age 59
    • female > male (8:1)
    • location: entire colon, may have left-sided sparing
    • chronic watery diarrhea
    • normal colonoscopy
    • cat scratch colon on endoscopy
    • associations: celiac disease, drugs (NSAIDs, SSRIs, PPI, simvastatin, lisinopril)

  • Histology

    • subepithelial collagen (thicker than normal, can entrap inflammatory cells, small capillaries)
    • superficial inflammation
      • intraepithelial lymphocytes
      • lamina propria plasma cells
    • occasional focal cryptitis
    • Paneth cell metaplasia = worse prognosis

  • Stains

    • Tenascin positive in collagen layer

  • Ddx

  • Signout

    • Colonic mucosa with increased lamina propria plasma cells and thickening of the subepithelial collagen plate, consistent with collagenous colitis
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