News and Views: July 27, 2018

Researchers at the University Research Clinic for Innovative Patient Pathways at Aarhus University in Denmark found a link between daily proton pump inhibitor (PPI) use and Collagenous Colitis.

In an article published in Helio  researchers “found an association with all PPIs…..(and) that it was strongest with the current use of lansoprazole for both Collagenous colitis and lymphocytic colitis.”

Lansoprazole is a popular PPI sold under the brand names Prevacid®, Prevacid® SoluTab®, and Prevacid® 24HR.

Symptoms of collagenous colitis

Collagenous colitis is an inflammatory bowel condition resulting from a solid band of collagen that develops under the colon.  This condition is somewhat rare with an incidence of fewer than 50 people out of 100,000 and the incidence rate is highest for adults over 45.

Some of the symptoms of collagenous colitis include:

• Frequent loose stools
• Bloating and gas
• A tired feeling
• Abdominal cramping and pain
• Nighttime accidental stool passage

These symptoms can vary in both intensity and duration, and they tend to last from a few weeks to months, and in some cases, years.

Risk factors for collagenous colitis

According to Mayo Clinic, risk factors for collagenous colitis include:

• Adults between 50 and 70 years-old
• Females are more prone to this condition
• Autoimmune diseases such as celiac disease, thyroid diseases, rheumatoid arthritis, type 1 diabetes, or psoriasis
• Smoking
• Family history
• Those taking select maintenance medications, including PPIs

Bile and collagenous colitis

Bile is a well-recognized agent in the progression of GERD. Bile is one element linked to Barrett’s esophagus and adenocarcinoma.

According to the NIH, some researchers believe that the malabsorption of bile is one potential cause of this disease. In other words, the intestines are unable to absorb bile, thus allowing it to reach the colon, where it can cause potentially severe and frequent diarrhea.

Diagnosing collagenous colitis

To diagnose collagenous colitis tissue samples taken from the colon are evaluated by a pathologist. It is interesting to note that the symptoms of collagenous colitis can be similar to Crohn’s disease, irritable bowel syndrome, and celiac disease; conditions that are often confused with GERD.

In addition to tissue samples, other tests might include a colonoscopy, CT scan, and an MRI.

Treating collagenous colitis

According to the Cleveland Clinic, collagenous colitis is usually treated via medications with dietary restrictions. In extreme cases, a surgical procedure may be required to remove a portion or all of the colon.

For any adult taking PPIs on a daily basis for an extended period, and experiencing the symptoms noted above, it is essential to have a full work up to determine the underlying causes, which can be one of many severe conditions.

Having looked at all the potential health risks associated with the daily long-term use of PPIs, this latest research suggests today may the time to consider alternative treatment approaches to find relief.