PMID- 29324472
OWN - NLM
STAT- MEDLINE
DCOM- 20190226
LR  - 20200130
IS  - 1532-0979 (Electronic)
IS  - 0147-5185 (Linking)
VI  - 42
IP  - 4
DP  - 2018 Apr
TI  - Collagenous Enteritis is Unlikely a Form of Aggressive Celiac Disease Despite 
      Sharing HLA-DQ2/DQ8 Genotypes.
PG  - 545-552
LID - 10.1097/PAS.0000000000001022 [doi]
AB  - Collagenous enteritis is an uncommon small intestinal injury pattern with unclear 
      pathogenesis. While it has been speculated that collagenous enteritis represents 
      a form of refractory celiac disease, recent clinical studies suggest a potential 
      link to exposure to the antihypertensive medication olmesartan. Here we 
      hypothesized that the pathogenesis of collagenous enteritis involves both genetic 
      and environmental factors. All subjects with biopsy-proven collagenous enteritis 
      diagnosed between 2002 and 2015 were identified from 2 tertiary care medical 
      centers. Human leukocyte antigen (HLA)-DQ genotyping was performed by polymerase 
      chain reaction on archived tissue. Celiac disease serology, past medical history, 
      medications, smoking history, demographics, histology, clinical management, and 
      follow-up were recorded. A total of 32 subjects were included. In contrast to 
      celiac disease, subjects with collagenous enteritis were mostly elderly (median 
      age at diagnosis, 69 y; range, 33 to 84 y). Seventy percent of collagenous 
      enteritis subjects harbored celiac disease susceptibility alleles HLA-DQ2/DQ8; 
      however, only 1 subject had elevated serum levels of celiac disease-associated 
      autoantibodies while on a gluten-containing diet. Furthermore, 56% of subjects 
      were taking nonsteroidal anti-inflammatory drugs, 36% proton-pump inhibitors, 28% 
      statins, and 32% olmesartan at the time of diagnosis. Discontinuation of 
      olmesartan and treatments with steroids and/or gluten-free diet resulted in 
      symptomatic and histologic improvement. Neither lymphoma nor collagenous 
      enteritis-related death was seen in this cohort. Therefore, while collagenous 
      enteritis shares similar HLA genotypes with celiac disease, the difference in 
      demographics, the lack of celiac disease-associated autoantibodies, and potential 
      link to medications as environmental triggers suggest the 2 entities are likely 
      distinct in pathogenesis.
FAU - Kung, Vanderlene Liu
AU  - Kung VL
AD  - Department of Pathology and Immunology, Washington University School of Medicine, 
      Saint Louis, MO.
FAU - Liu, Ta-Chiang
AU  - Liu TC
AD  - Department of Pathology and Immunology, Washington University School of Medicine, 
      Saint Louis, MO.
FAU - Ma, Changqing
AU  - Ma C
AD  - Department of Pathology, School of Medicine, University of Pittsburgh, 
      Pittsburgh, PA.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PL  - United States
TA  - Am J Surg Pathol
JT  - The American journal of surgical pathology
JID - 7707904
RN  - 0 (Angiotensin II Type 1 Receptor Blockers)
RN  - 0 (HLA-DQ Antigens)
RN  - 0 (HLA-DQ2 antigen)
RN  - 0 (HLA-DQ8 antigen)
RN  - 0 (Steroids)
RN  - 9007-34-5 (Collagen)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Angiotensin II Type 1 Receptor Blockers/adverse effects
MH  - Biopsy
MH  - Celiac Disease/classification/*genetics/immunology/pathology
MH  - Collagen/*analysis
MH  - Collagenous Sprue/classification/*genetics/metabolism/therapy
MH  - Diet, Gluten-Free
MH  - Enteritis/classification/*genetics/metabolism/therapy
MH  - Female
MH  - Genetic Predisposition to Disease
MH  - HLA-DQ Antigens/*genetics/immunology
MH  - Humans
MH  - Intestine, Small/*chemistry/drug effects/pathology
MH  - Male
MH  - Middle Aged
MH  - Missouri
MH  - Pennsylvania
MH  - Phenotype
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Steroids/therapeutic use
MH  - Treatment Outcome
EDAT- 2018/01/13 06:00
MHDA- 2019/02/27 06:00
CRDT- 2018/01/12 06:00
PHST- 2018/01/13 06:00 [pubmed]
PHST- 2019/02/27 06:00 [medline]
PHST- 2018/01/12 06:00 [entrez]
AID - 10.1097/PAS.0000000000001022 [doi]
PST - ppublish
SO  - Am J Surg Pathol. 2018 Apr;42(4):545-552. doi: 10.1097/PAS.0000000000001022.