What rheumatic disorders are associated with pouchitis, lymphocytic colitis (LC), and collagenous colitis (CC)?
- Pouchitis is inflammation of the ileal pouch created following colectomy for UC. It occurs in up to 40% to 60% of patients having this surgery. Patients present with watery or bloody diarrhea. Some develop arthritic manifestations. Treatment includes metronidazole and ciprofloxacin. Surgical revision may be necessary in treatment-resistant cases.
- Rheumatic Disorders Associated with Pouchitis, Lymphocytic Colitis, and Collagenous Colitis
Pouchitis | LC | CC | |
---|---|---|---|
IBD-like peripheral inflammatory arthritis | Yes | Yes | Yes |
Rheumatoid arthritis | No | Yes | Yes |
Ankylosing spondylitis * | No | No | No |
Thyroiditis or other autoimmune disease | No | Yes | Yes |
CC, Collagenous colitis; IBD, inflammatory bowel disease; LC, lymphocytic colitis.
* Up to 60% of patients with ankylosing spondylitis have asymptomatic Crohn-like lesions on right-sided colon biopsies. However, only 4% to 5% will evolve into overt inflammatory bowel disease.
- Microscopic colitis includes both LC and CC. Patients present with watery diarrhea and may develop arthritic manifestations (10%-20%) or autoimmune thyroiditis.
- Patients older than 65 years (80%) and females (60%) are most commonly affected.
- The diagnosis can only be made by tissue histologic examination obtained by colonoscopy.
- Budesonide is effective for inducing and maintaining clinical and histologic remission for CC and LC, and loperamide may ameliorate diarrhea .
- Evidence for benefit of bismuth subsalicylate and mesalamine with or without cholestyramine for treatment of CC or LC is weak.