IBD

[Carolina03]

Thanks for your insight on the following questions.

My health took a downturn after my second and third pregnancies. After all the relevant tests, I was diagnosed w/ Collagenous Colitis and Aortic Insufficiency, both rare for someone my age (36) and fitness level. The symptoms are moderate but concerning: my left ventricle has begun to dilate. Systolic function is still normal.  

1) How are IBD & AI interrelated, i.e., what are the organic etiologies?

2) Would treatment differ for someone w/ both diseases and how so?

3) I am an anomaly for the physicians locally -- I live in a small community. How can I find the best interdisciplinary approach to improve my prognosis and life quality? Do you know a physician at the Cleveland Clinic or elsewhere who has experience treating patients w/ both diseases?

4) Any suggestions on how I could minimize progress of both diseases -- should I quit drinking wine, take nutritional supplements, etc.?

[Kevin Pho, MD]

1) Inflammatory bowel disease is associated with aortitis - which is an inflammation of the aorta.  Subsequent inflammation of the aorta results in dilation leading the insufficiency.

2) Treating the underlying inflammatory disease would help treat the inflammation of the aorta.  Medications such as steroids and methotrexate have been shown to help with the aortic inflammation.  These medications can also be considered in the treatment of the inflammatory bowel disease.

3) I would suggest the nearest academic medication center would be the best course of action.  I am not affiliated with the Cleveland Clinic, so I do not have any personal recommendations.  You can find a gastroenterologist from this site:
http://www.abim.org/dp/apps/physdir1.htm

4) As mentioned above, you may want to consider some kind of steroid therapy or immunomodulating therapy to help treat the underlying disease.  Steroid therapy would be the most reasonable medication to minimize the progress of both diseases - this should be discussed with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[Carolina03]

Thanks; I couldn't have come up w/ that info on my own, and doubt that anyone near by could've either. I'll follow up, etc.

Peace,

Carolina03

[PAJ]

Infection , looks like the most probable cause & links both conditions read the articles below see if  you relate to the information .





Organic Etiologies.
Organic refers to a condition caused by a known medical condition

http://qurlyjoe.bu.edu/cducibs/colcolfaq.html

http://www.mercola.com/2003/sep/13/inflammatory_bowel_disease.htm

Collagenous colitis is a condition characterized by chronic, watery diarrhoea, which is diagnosed histologically as most cases reveal a normal colonoscopic appearance. The aetiology is poorly understood, but nonsteroidal anti-inflammatory drugs or infections may act as triggers for an immune-mediated process. In this report, an unusual case of collagenous colitis associated with pseudomembrane formation is described. Stool assay was negative for Clostridium difficile cytotoxin B. There are only three reports of pseudomembranes in collagenous colitis in the absence of C. difficile infection. In addition, the patient had a deficiency in immunoglobulin production, which may suggest an infective trigger to collagenous colitis. This is the first report of an association between an immunoglobulin deficiency and this unusual variant of collagenous colitis. The implications of these findings are discussed.

PMID: 12923382 [PubMed - in process]

Prevalence of microscopic colitis in patients with symptoms suggesting irritable bowel syndrome.

Tuncer C, Cindoruk M, Dursun A, Karakan T.

Gazi University Faculty of Medicine, Department of Gastroenterology, Ankara.

GOALS/BACKGROUND: Irritable bowel syndrome is a common disorder affecting 20% of the general population. It shows certain characteristics with organic bowel diseases. Definition of lymphocytic and collagenous colitis has created a new approach towards chronic idiopathic diarrheas. We searched for the frequency of lymphocytic and collagenous colitis in patients with irritable bowel syndrome. STUDY: The study group consisted of 30 irritable bowel patients and 20 controls. Multiple biopsies from cecum; ascendant, transverse and descendent colon; sigmoid and rectum were taken sequentially in all patients. RESULTS: We diagnosed 7 out of 30 irritable bowel patients as having lymphocytic colitis (23.3%) but none as having collagenous colitis. In the control group 1 out of 20 patients had lymphocytic colitis (5%) and none had collagenous colitis. Irritable bowel patients had higher rate of lymphocytic colitis association (p < 0.05). CONCLUSIONS: Functional disorders of the bowel should be searched for possible lymphocytic colitis, especially in cases refractory to classical therapies.

PMID: 12891921 [PubMed - indexed for MEDLINE]

Aortic aneurysms can develop anywhere along the length of the aorta, but 3/4 are located in the abdominal aorta. Thoracic aortic aneurysms, including those that extend from the descending thoracic aorta into the upper abdomen (thoracoabdominal aneurysms), account for 1/4 of aortic aneurysms.
Aortic aneurysms may be fusiform or, less commonly, saccular. Fusiform aneurysms are characterized by circumferential widening of the aorta, whereas saccular aneurysms represent localized outpocketings of the aortic wall. Laminated thrombus often lines the walls of aortic aneurysms.
Etiology
Arteriosclerosis, the most common disease associated with aortic aneurysms, may weaken the aortic wall, causing it to expand. Hypertension and cigarette smoking contribute to the degenerative process. Trauma, arteritis, and mycotic aneurysms are less frequent causes. Mycotic aneurysms occur at sites of localized bacterial or fungal infections in the aortic or arterial walls. These sites of infection usually are the result of metastatic infection from septicemia, most commonly caused by infectious endocarditis. Infection may also spread to blood vessel walls locally, and preexisting aortic or arterial aneurysms may become infected, usually from bloodstream seeding. Although virtually any bacterial or fungal pathogen may infect aneurysms, Salmonella sp show a proclivity for vascular tissues.
http://www.merck.com/pubs/mmanual/section16/chapter211/211a.htm