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01-12-2021 | Budesonide | Case Report

Novel Case Report: A Previously Reported, but Pathophysiologically Unexplained, Association Between Collagenous Colitis and Protein-Losing Enteropathy May Be Explained by an Undetected Link with Collagenous Duodenitis

Authors: Inayat Gill, Aciel Ahmed Shaheen, Ahmed Iqbal Edhi, Mitual Amin, Ketan Rana, Mitchell S. Cappell

Published in: Digestive Diseases and Sciences | Issue 12/2021

Abstract

Collagenous colitis (CC) is associated with non-bloody, watery diarrhea, which is pathophysiologically reasonable because normal colonic absorption (or excretion) of water and electrolytes can be blocked by the abnormally thick collagen layer in CC. However, CC has also been associated with six previous cases of protein-losing enteropathy (PLE), with no pathophysiologic explanation. The colon does not normally absorb (or excrete) amino acids/proteins, which is primarily the function of the small bowel. Collagenous duodenitis (CD) has not been associated with PLE. This work reports a novel case of CD (and CC) associated with PLE; a pathophysiologically reasonable mechanism for CD causing PLE (by the thick collagen layer of CD blocking normal intestinal amino acid absorption); and a novel association of PLE with severe COVID-19 infection (attributed to relative immunosuppression from hypoproteinemia, hypoalbuminemia, hypogammaglobulinemia, and malnutrition from PLE).

CD herein denotes collagenous duodenitis and not Crohn’s disease.

Excludes references with collagenous gastritis without collagenous duodenitis, because the stomach is not physiologically an important site of amino acid absorption, and therefore a thickened gastric collagen layer should not pathophysiologically cause protein-losing enteropathy [20‐22].

Boland K, Nguyen GC. Microscopic colitis: a review of collagenous and lymphocytic colitis. Gastroenterol Hepatol (N Y) 2017;13:671–677

Almadhoun OF, Katzman PJ, Rossi T. Collagenous colitis associated with protein losing enteropathy in a toddler. Case Rep Gastrointest Med. 2014. https://doi.org/10.1155/2014/209624.CrossRefPubMedPubMedCentral

Sano S, Yamagami K, Tanaka A, Nishio M, Nakamura T, Kubo Y et al. A unique case of collagenous colitis presenting as protein-losing enteropathy successfully treated with prednisolone. World J Gastroenterol 2008;14:6083–6086. https://doi.org/10.3748/wjg.14.6083.CrossRefPubMedPubMedCentral

Nakaya Y, Hosokawa SK, Kataoka Y, Hirabayashi M, Yamamoto S, Takasu K, Kitamura S, Omae T, Yoshimatsu Y. Acute onset collagenous colitis associated with protein-losing enteropathy. J Gen Fam Med 2017;18:135–137. https://doi.org/10.1002/jgf2.13.CrossRefPubMedPubMedCentral

Ozeki T, Ogasawara N, Izawa S, Mizuno M, Yanamoto K, Noda H, Okaniwa N, Tanabe A, Sasaki M, Kasugai K. Protein-losing enteropathy associated with collagenous colitis cured by withdrawal of a proton pump inhibitor. Intern Med 2013;52:1183–1187. https://doi.org/10.2169/internalmedicine.52.0232.CrossRefPubMed

Stark ME, Batts KP, Alexander GL. Protein-losing enteropathy with collagenous colitis. Am J Gastroenterol 1992;87:780–783PubMed

Raimo J, Coronel M, Criss A, Storch I. Collagenous colitis associated with protein losing enteropathy presenting with multiple venous thromboses. Am J Gastroenterol 2010;105:S342CrossRef

Patrick F, Hagihara PF, Griffen WO Jr. Physiology of the colon and rectum. Surg Clin North Am 1972;52:797–805. https://doi.org/10.1016/s0039-6109(16)39779-1.CrossRef

Kim YJ, Satapathy S, Iqbal S, Cerulli M. Collagenous duodenitis in patient with collagenous colitis. Am J Gastroenterol 2010;105:S183–S184CrossRef

10.

Meier PN, Otto P, Ritter M, Stolte M. Collagenous duodenitis and ileitis in a patient with collagenous colitis. Leber Magen Darm 1991;21:231–232PubMed

11.

Soeda A, Mamiya T, Hiroshima Y, Sugiyama H, Shidara S, Dai Y, Nakahara A, Ikezawa K. Collagenous gastroduodenitis coexisting repeated Dieulafoy ulcer: a case report and review of collagenous gastritis and gastroduodenitis without colonic involvement. Clin J Gastroenterol 2014;7:402–409. https://doi.org/10.1007/s12328-014-0526-y.CrossRefPubMed

12.

Koide T, Mochizuki T, Kawai N, Yashiro K, Inoue T, Tsujimoto M, Nishigaki T. Collagenous gastroduodenitis with recurrent gastric ulcer in 12-year-old-girl. Pediatr Int 2015;57:754–757. https://doi.org/10.1111/ped.12615.CrossRefPubMed

13.

Rustagi T, Rai M, Scholes JV. Collagenous gastroduodenitis. J Clin Gastroenterol 2011;45:794–799. https://doi.org/10.1097/MCG.0b013e31820c6018.CrossRefPubMed

14.

Navarro-Llavat M, Domenech E, Masnou H, Ojanguren I, Manosa M, Lorenzo-Zuniga V et al. Collagenous duodeno-ileo-colitis with transient IgG deficiency preceded by Yersinia enterocolitica intestinal infection: case report and review of literature. Gastroenterol Hepatol 2007;30:219–221. https://doi.org/10.1157/13100588.CrossRefPubMed

15.

Cocq P, Scrumeda D, Baron P, Duthoit D, Korgami B, Colombel JK. Collagenous gastritis, duodenitis, ileitis and colitis. Gastroenterol Clin Biol 2011;25:1027–1029

16.

Schreiber FS, Eidt S, Hidding M, Schmidt-Walczuch J, Werning C. Collagenous duodenitis and collagenous colitis: a short clinical course as evidenced by sequential endoscopic and histologic findings. Endoscopy 2001;33:555. https://doi.org/10.1055/s-2001-14968.CrossRefPubMed

17.

Stolte M, Ritter M, Borchard F, Koch-Scherrer G. Collagenous gastroduodenitis on collagenous colitis. Endoscopy 1990;22:186–187. https://doi.org/10.1055/s-2007-1012837.CrossRefPubMed

18.

Borchard F, Niederau C. Collagenous gastroduodenitis. Dtsch Med Wochenschr 1989;114:1345PubMed

19.

Eckstein RP, Dowsett JF, Riley JW. Collagenous enterocolitis: a case of collagenous colitis with involvement of the small intestine. Am J Gastroenterol 1988;83:767–771PubMed

20.

Gopal P, McKenna BJ. The collagenous gastroenteritides: similarities and differences. Arch Pathol Lab Med 2010;134:1485–1489. https://doi.org/10.1043/2010-0295-CR.1.CrossRefPubMed

21.

Nielsen OH, Riis LB, Danese S, Bojesen RD, Soendergaard C. Proximal collagenous gastroenteritides: clinical management. A systematic review. Ann Med 2014;46:311–317. https://doi.org/10.3109/07853890.2014.899102.CrossRefPubMed

22.

Chen B, Popescu O, Barker C. A226 pediatric collagenous gastritis: endoscopic and histologic evolution. J Can Assoc Gastroenterol 2018;1:394–396. https://doi.org/10.1093/jcag/gwy008.227.CrossRefPubMedCentral

23.

Jaruvongvanich V, Poonsombudlert K, Ungprasert P. Smoking and risk of microscopic colitis: a systematic review and meta-analysis. Inflamm Bowel Dis 2019;25:672–678. https://doi.org/10.1093/ibd/izy296.CrossRefPubMed

24.

Perrault J, Markowitz H. Protein-losing gastroenteropathy and the intestinal clearance of serum-alhpa-1-antitrypsin. Mayo Clin Proc 1984;59:278–279. https://doi.org/10.1016/s0025-6196(12)61263-4.CrossRefPubMed

25.

Cappell MS, Edhi A, Amin M. Case report of primary intestinal lymphangiectasia diagnosed in an octogenarian by ileal intubation and by push enteroscopy after missed diagnosis by standard colonoscopy and EGD. Medicine 2018;97:e9649. https://doi.org/10.1097/MD.0000000000009649.CrossRefPubMedPubMedCentral

26.

Levitt DG, Levitt MD. Protein losing enteropathy: comprehensive review of the mechanistic association with clinical and subclinical disease states. Clin Exp Gastroenterol 2017;10:147–168. https://doi.org/10.2147/CEG.5136803.CrossRefPubMedPubMedCentral

27.

Shor J, Churrango G, Hosseini N, Marshall C. Management of microscopic colitis: challenges and solutions. Clin Exp Gasteroenterol 2019;12:111–120. https://doi.org/10.2147/CEG.S165047.CrossRef

28.

Freeman HJ. Collagenous sprue. Can J Gasteroenterol 2011;25:189–192. https://doi.org/10.1155/2011/821976.CrossRef

29.

Soendergaard C, Buhl Riis L, Haagen Nielsen O. Collagenous sprue: a coeliac disease look-alike with different treatment strategy. BMJ Case Rep 2014;2014:bcr2014203721. https://doi.org/10.1136/bcr-2014-203721.CrossRefPubMedPubMedCentral

30.

Castellano VM, Muñoz MT, Colina F, Nevado M, Casis B, Solís-Herruzo JA. Collagenous gastrobulbitis and collagenous colitis: case report and review of the literature. Scand J Gastroenterol 1990;34:632–638. https://doi.org/10.1080/003655299750026128.CrossRef

31.

Fung M, Babik JM. COVID-19 in immunocompromised hosts: what we know so far. Clin Infect Dis. 2020. https://doi.org/10.1093/cid/ciaa863.CrossRefPubMedPubMedCentral

32.

CDC (Centers for Disease Control and Prevention). Your health: evidence used to update the list of underlying medical conditions that increase a person’s risk of severe illness from COVID-19. www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/evidence-table.html

33.

Payette C, Terry AT. ACEP (American College of Emergency Physicians). COVID-19 field guide: immunocompromised patients-special populations. https://www.acep.org/corona/covid-19-field-guide/special-populations/immunosuppressed-patients/

34.

Wong SH, Lui RN, Sung JJ. COVID-19 and the digestive system. J Gastroenterol Hepatol 2020;35:744–748. https://doi.org/10.1111/jgh.15047.CrossRefPubMed

35.

Pan L, Mu M, Yang P, Sun Y, Wang R, Yan J et al. Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: a descriptive, cross sectional, multicenter study. Am J Gastroenterol. 2020;115:766–773. https://doi.org/10.14309/ajg.0000000000000620.CrossRefPubMed

36.

Cappell MS. Moderately severe diarrhea and impaired renal function with COVID-19 infection. Am J Gastroenterol 2020;115:947–948. https://doi.org/10.14309/ajg.0000000000000681.CrossRefPubMed

37.

Walls AC, Park YJ, Tortorici A, Wall A, McGuire AT, Veesler D. Structure, function and antigenicity of the SARS-CoV-2 spike glycoprotein. Cell 2020;181:281-292.e6. https://doi.org/10.1016/j.cell.2020.02.058.CrossRefPubMedPubMedCentral

38.

Miehlke S, Guagnozzi D, Zabana Y, Tontini GE, Fiehn AK, Wildt S et al. European guidelines on microscopic colitis: United European Gastroenterology (UEG) and European Microscopic Colitis Group (EMCG) statements and recommendations. United Eur Gastroenterol J. 2020. https://doi.org/10.1177/2050640620951905.CrossRef

Title: Novel Case Report: A Previously Reported, but Pathophysiologically Unexplained, Association Between Collagenous Colitis and Protein-Losing Enteropathy May Be Explained by an Undetected Link with Collagenous Duodenitis
Authors: Inayat Gill
Aciel Ahmed Shaheen
Ahmed Iqbal Edhi
Mitual Amin
Ketan Rana
Mitchell S. Cappell
Publication date: 01-12-2021
Publisher: Springer US
Keywords: Budesonide
Malnutrition
Diarrhea
COVID-19
Esophagogastroduodenoscopy
Celiac Disease
Celiac Disease
Diarrhea
Published in: Digestive Diseases and Sciences / Issue 12/2021
Print ISSN: 0163-2116
Electronic ISSN: 1573-2568
DOI: https://doi.org/10.1007/s10620-020-06804-3

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