Lansoprazole
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Collagenous colitis in an elderly patient: case report An 82-year-old man developed collagenous colitis during treatment with lansoprazole for reflux oesophagitis. Twenty days after the introduction of oral lansoprazole 30 mg/day in 2005, the man developed watery diarrhoea with > 10 episodes daily. Colonoscopy revealed nothing abnormal, and his symptoms subsided after trimebutine was started for irritable bowel syndrome. However, he continued to have around three episodes of watery diarrhoea per day. Colonoscopy performed in 2006 showed slight reddening over the whole colon; repeat colonoscopy in 2007 revealed reduced vascular transparency from the caecum to the transverse colon with oedematous granular mucosa. He presented for endoscopic follow-up in November 2008. Reflux oesophagitis was noted, and chronic inflammatory cell infiltration was evident on gastric biopsy. Colonoscopy confirmed caecum reddening with vascular transparency, mucosal oedema and granulation with a mesh-like construction of blood vessels. Mucosal granulation extended from the ascending colon to the transverse colon. Biopsy of the granular mucosa revealed an eosinophilic non-structured substance deposited in a band, identified as a subepithelial collagen band. Collagenous colitis was subsequently diagnosed; lansoprazole was suspected. The man’s watery diarrhoea resolved 1 week after the replacement of lansoprazole with omeprazole. Follow-up colonoscopy in April 2009 revealed an improvement in the oedematous, granular changes to the right side of the colonic mucosa. No collagen band was notable in biopsy samples taken from various sites from the caecum to the rectum. Author comment: It is thought that the collagenous colitis was not caused by NSAIDs but by lansoprazole. Nakayama N, et al. A case of collagenous colitis with an endoscopic follow up Review of 123 Japanese cases. Gastroenterological Endoscopy 52: 1888-1894, No. 803046323 8, Aug 2010 [Japanese; summarised from a translation] - Japan
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Reactions 8 Jan 2011 No. 1333
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