В настоящее время наблюдается рост заболеваемости микроскопическими колитами. Существуют трудности в диагностике данного заболевания из-за непостоянства гистологических признаков, вариабельности морфологических изменений слизистой оболочки толстой кишки в различных ее отделах, сочетания у пациента не только различных форм микроскопических колитов, но и других заболеваний кишечника. В статье приводится описание дифференциального диагноза, примера его постановки и успешного лечения различных форм микроскопического колита будесонидом (представлены два клинических случая).
Currently, there is an increase in the incidence of microscopic colitis. There are difficulties in diagnosing this disease due to the variability of histological signs, variability of morphological changes in the mucous membrane of the colon in different parts of the colon, and the combination in one patient of not only various forms of microscopic colitis, but also other intestinal diseases. The article describes the differential diagnosis, an example of its staging and successful treatment of various forms of microscopic colitis with budesonide (two clinical cases presented).
1. Miehlke S, Guagnozzi D, Zabana Y, et al. European guidelines on microscopic colitis: United European Gastroenterology and European Microscopic Colitis Group statements and recommendations. United European Gastroenterol J. 2021;9(1):13-37. DOI:10.1177/2050640620951905
2. Nielsen JA, Steephen A, Lewin M. Angiotensin-II inhibitor (olmesartan)-induced collagenous sprue with resolution following discontinuation of drug. World J Gastroenterol. 2013;19(40):6928-30. DOI:10.3748/wjg.v19.i40.6928
3. Jaruvongvanich V, Poonsombudlert K, Ungprasert P. Smoking and risk of microscopic colitis: A systematic review and meta-analysis. Inflamm Bowel Dis. 2019;25:672-8. DOI:10.1093/ibd/izy296
4. Barrett K. Microscopic colitis: A guide for general practice. Br J Gen Pract. 2020;71(702):41-2. DOI:10.3399/bjgp21X714593
5. Miehlke S, Heymer P, Bethke B, et al. Budesonide treatment for collagenous colitis: A randomized, double-blind, placebo-controlled, multicenter trial. Gastroenterology. 2002;123(4):978-84. DOI:10.1053/gast.2002.36042
6. Bonderup OK, Hansen JB, Birket-Smith L, et al. Budesonide treatment of collagenous colitis: A randomised, double blind, placebo controlled trial with morphometric analysis. Gut. 2003;52(2):248-51. DOI:10.1136/gut.52.2.248
7. Miehlke S, Madisch A, Kupcinskas L, et al. BUC-60/COC Study Group. Budesonide is more effective than mesalamine or placebo in short-term treatment of collagenous colitis. Gastroenterology. 2014;146(5):1222-30.e1-2. DOI:10.1053/j.gastro.2014.01.019
8. Temmerman F, Baert F. Collagenous and lymphocytic colitis: systematic review and update of the literature. Dig Dis. 2009;27(Suppl. 1):137-45. DOI:10.1159/000268134
9. Bonderup OK, Hansen JB, Teglbjaerg PS, et al. Long-term budesonide treatment of collagenous colitis: A randomised, double-blind, placebo-controlled trial. Gut. 2009;58(1):68-72. DOI:10.1136/gut.2008.156513
10. Nguyen GC, Smalley WE, Vege SS, Carrasco-Labra A; Clinical Guidelines Committee. American Gastroenterological Association Institute Guideline on the medical management of microscopic colitis. Gastroenterology. 2016;150(1):242-6; quiz e17-8. DOI:10.1053/j.gastro.2015.11.008
11. Sonnenberg A, Genta RM. Temporal changes in the histology of microscopic colitis. J Crohns Colitis. 2022;16(9):1415-9. DOI:10.1093/ecco-jcc/jjac046
12. Khalili H, Axelrad JE, Roelstraete B, et al. Gastrointestinal infection and risk of microscopic colitis: A nationwide case-control study in Sweden. Gastroenterology.
2021;160(5):1599-607.e5. DOI:10.1053/j.gastro.2021.01.004
13. Фадеева Н.А., Осадчук А.М., Куколева Е.О., и др. Проблемы диагностики и лечения сочетания целиакии и микроскопического колита. Эффективная фармакотерапия. 2022;18(22):112-6 [Fadeeva NA, Osadchuk AM, Kukoleva EO, et al. The problems of diagnosis and treatment the comorbidity of celiac disease and miscroscopic colitis. Effective Pharmacotherapy. 2022;18(22):112-6 (in Russian)]. DOI:10.33978/2307-3586-2022-18-22-112-116
14. Virine B, Chande N, Driman DK. Biopsies from ascending and descending colon are sufficient for diagnosis of microscopic colitis. Clin Gastroenterol Hepatol. 2020;18(9):2003-9. DOI:10.1016/j.cgh.2020.02.036
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1. Miehlke S, Guagnozzi D, Zabana Y, et al. European guidelines on microscopic colitis: United European Gastroenterology and European Microscopic Colitis Group statements and recommendations. United European Gastroenterol J. 2021;9(1):13-37. DOI:10.1177/2050640620951905
2. Nielsen JA, Steephen A, Lewin M. Angiotensin-II inhibitor (olmesartan)-induced collagenous sprue with resolution following discontinuation of drug. World J Gastroenterol. 2013;19(40):6928-30. DOI:10.3748/wjg.v19.i40.6928
3. Jaruvongvanich V, Poonsombudlert K, Ungprasert P. Smoking and risk of microscopic colitis: A systematic review and meta-analysis. Inflamm Bowel Dis. 2019;25:672-8. DOI:10.1093/ibd/izy296
4. Barrett K. Microscopic colitis: A guide for general practice. Br J Gen Pract. 2020;71(702):41-2. DOI:10.3399/bjgp21X714593
5. Miehlke S, Heymer P, Bethke B, et al. Budesonide treatment for collagenous colitis: A randomized, double-blind, placebo-controlled, multicenter trial. Gastroenterology. 2002;123(4):978-84. DOI:10.1053/gast.2002.36042
6. Bonderup OK, Hansen JB, Birket-Smith L, et al. Budesonide treatment of collagenous colitis: A randomised, double blind, placebo controlled trial with morphometric analysis. Gut. 2003;52(2):248-51. DOI:10.1136/gut.52.2.248
7. Miehlke S, Madisch A, Kupcinskas L, et al. BUC-60/COC Study Group. Budesonide is more effective than mesalamine or placebo in short-term treatment of collagenous colitis. Gastroenterology. 2014;146(5):1222-30.e1-2. DOI:10.1053/j.gastro.2014.01.019
8. Temmerman F, Baert F. Collagenous and lymphocytic colitis: systematic review and update of the literature. Dig Dis. 2009;27(Suppl. 1):137-45. DOI:10.1159/000268134
9. Bonderup OK, Hansen JB, Teglbjaerg PS, et al. Long-term budesonide treatment of collagenous colitis: A randomised, double-blind, placebo-controlled trial. Gut. 2009;58(1):68-72. DOI:10.1136/gut.2008.156513
10. Nguyen GC, Smalley WE, Vege SS, Carrasco-Labra A; Clinical Guidelines Committee. American Gastroenterological Association Institute Guideline on the medical management of microscopic colitis. Gastroenterology. 2016;150(1):242-6; quiz e17-8. DOI:10.1053/j.gastro.2015.11.008
11. Sonnenberg A, Genta RM. Temporal changes in the histology of microscopic colitis. J Crohns Colitis. 2022;16(9):1415-9. DOI:10.1093/ecco-jcc/jjac046
12. Khalili H, Axelrad JE, Roelstraete B, et al. Gastrointestinal infection and risk of microscopic colitis: A nationwide case-control study in Sweden. Gastroenterology.
2021;160(5):1599-607.e5. DOI:10.1053/j.gastro.2021.01.004
13. Fadeeva NA, Osadchuk AM, Kukoleva EO, et al. The problems of diagnosis and treatment the comorbidity of celiac disease and miscroscopic colitis. Effective Pharmacotherapy. 2022;18(22):112-6 (in Russian). DOI:10.33978/2307-3586-2022-18-22-112-116
14. Virine B, Chande N, Driman DK. Biopsies from ascending and descending colon are sufficient for diagnosis of microscopic colitis. Clin Gastroenterol Hepatol. 2020;18(9):2003-9. DOI:10.1016/j.cgh.2020.02.036
1ГБУЗ «Московский клинический научно-практический центр им. А.С. Логинова» Департамента здравоохранения г. Москвы, Москва, Россия; 2ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия; 3ГБУ «Научно-исследовательский институт организации здравоохранения и медицинского менеджмента» Департамента здравоохранения г. Москвы, Москва, Россия
*a.m.osadchuk2020mail.ru
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Alexey M. Osadchuk*2, Nina A. Fadeeva1,3, Nuriya A. Dashkina1, Irina D. Loranskaya2, Sergey G. Khomeriki1
1Loginov Moscow Clinical Scientific and Practical Center, Moscow, Russia; 2Russian Medical Academy of Continuous Professional Education, Moscow, Russia; 3Research Institute of Health Organization and Medical Management, Moscow, Russia
*a.m.osadchuk2020mail.ru