Recently, there have been reports of lansoprazole-associated
collagenous colitis manifesting some characteristic clinical findings: chronic
diarrhea, typical endoscopic findings, pathological evidence of collagen bands,
and rapid clinical improvement after discontinuation of lansoprazole. We have
also often encountered patients taking lansoprazole presenting with chronic
diarrhea and typical endoscopic findings. Although one published article has
stated that linear ulcers and ulcer scars should be considered specific for
lansoprazole-associated collagenous colitis, another has not mentioned
endoscopic findings at all [1]
[2].
However, severe ulcers rarely cause colonic perforation [3]. Here we present a patient with lansoprazole-associated
collagenous colitis who presented a unique clinical picture, similar to that of
ischemic colitis.
A 78-year-old Japanese woman attended our emergency room because of
abrupt onset of lower abdominal pain and heavy blood in her stool. She had been
taking lansoprazole since 2 months and had chronic diarrhea. Initially,
ischemic colitis was suspected and an abdominopelvic computed tomography (CT)
scan revealed a thick-walled and edematous sigmoid colon ([Fig. 1]). Colonoscopy was performed to confirm the
diagnosis and revealed a 20-cm long hemorrhagic, linear ulcer and a 15-cm
linear ulcer scar in the sigmoid colon ([Fig. 2]).
Histopathological examination of biopsy samples taken from the sigmoid colon
showed subepithelial collagen bands ([Fig. 3]).
Finally, a diagnosis of collagenous colitis was made. The cause was though to
be lansoprazole and this was discontinued. Six days later, the patient was
discharged with complete resolution of the diarrhea and abdominal pain. A
repeat colonoscopy 2 months after admission showed healing linear lesions and
scars ([Fig. 4]). No collagen bands were
identified on a biopsy specimen.
Fig. 1 Abdominopelvic computed
tomography (CT) scan demonstrating the thick-walled sigmoid colon.
Fig. 2 Colonoscopy showing an
actively hemorrhagic linear ulcer and a linear ulcer scar.
Fig. 3 Biopsy specimen showing
markedly thickened subepithelial collagen bands.
Fig. 4 Follow-up colonoscopy
revealed the complete healing of the linear ulcer.
The present case highlights the fact that lansoprazole-associated
collagenous colitis may present with atypical clinical, imaging, and endoscopic
findings.
Endoscopy_UCTN_Code_CCL_1AD_2AJ
