Zusammenfassung
Ein 57-jähriger Mann entwickelte chronische, wässrige Durchfälle vier Wochen nach einer Lansoprazol-beinhaltenden Helicobacter-pylori-Eradikationstherapie gefolgt von einer Lansoprazol-Monotherapie wegen einer gastroösophagealen Refluxerkrankung. Vier Wochen später wurde der Patient in unserem Spital aufgenommen. Nach ausführlicher Diagnostik ließen sich andere Ursachen der Diarrhö, wie z. B. Infektionen einschließlich einer Clostridium-difficile-Kolitis, ausschließen. In der Endoskopie fand sich eine unauffällige Dickdarmschleimhaut, die entnommenen Stufenbiopsien zeigten das charakteristische histologische Bild einer Kollagenkolitis. Das Absetzen von Lansoprazol führte zur raschen und anhaltenden Beschwerdefreiheit. Zwei Monate später ergab die Koloskopiekontrolle einschließlich Stufenbiopsien keinen Hinweis mehr für eine Kollagenkolitis. Die Kollagenkolitis als Variante der mikroskopischen Kolitis ist eine seltene Ursache chronischer Diarrhö, die Pathogenese ist unbekannt. Diese Kasuistik beschreibt die seltene Assoziation einer Medikation mit dem Protonenpumpeninhibitor Lansoprazol und des Auftretens einer Kollagenkolitis und unterstreicht die Wichtigkeit einer genauen Medikamentenanamnese bei Patienten mit mikroskopischer Kolitis.
Abstract
A 57-year-old man developed chronic, watery diarrhea four weeks after Helicobacter pylori eradication therapy including lansoprazole followed by lansoprazole monotherapy for gastroesophageal reflux disease. Four weeks later the patient was admitted to our hospital. By repeated testing other causes of diarrhea, e. g., infectious diarrhea including Clostridium difficile colitis were excluded. Endoscopy showed a normal colon, histopathology of random biopsies of all sections of the colon demonstrated the characteristic features of collagenous colitis. Withdrawal of lansoprazole lead to prompt and sustained relief. Two months later repeat colonoscopy with biopsies showed no evidence of collagenous colitis. Collagenous colitis as a subtype of microscopic colitis is a rare cause of chronic diarrhea with unknown pathogenesis. The reported case represents an unusual association between medication with the proton pump inhibitor lansoprazole and the development of collagenous colitis suggesting the importance of evaluation of drug use in patients with microscopic colitis.
Schlüsselwörter
Kollagenkolitis - Lansoprazol - Diarrhö
Key words
Collagenous colitis - lansoprazole - diarrhea
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Dr. Martin Rammer
1st Medical Department, Division of Gastroenterology, General Hospital Wels
Grieskirchnerstraße 42
4600 Wels
Austria
Phone: ++ 43/72 42/4 15-21 81
Fax: ++ 43/72 42/4 15-39 86
Email: martin.rammer@klinikum-wels.at
