Mechanisms of diarrhea in collagenous colitis

Background & Aims: Collagenous colitis is an inflammatory disease of unknown etiology with diarrhea as the leading symptom. The aim of this study was to examine the pathogenic mechanisms of this disease. Methods: Biopsy specimens of the sigmoid colon were obtained endoscopically. Short-circuit current and 22Na and 36Cl fluxes were measured in miniaturized Ussing chambers. Alternating current impedance analysis discriminated epithelial from subepithelial resistance. Tight junction proteins occludin and claudin 1–5 were characterized in membrane fractions by Western blotting. Apoptotic ratio was determined by DAPI and TUNEL staining. Results: In collagenous colitis, net Na+ flux decreased from 8.8 ± 1.8 to 0.2 ± 1.5 and net Cl− flux from 11.2 ± 3.0 to −3.0 ± 2.7 μmol · h−1 · cm−2, indicating a pronounced decrease in NaCl absorption. The fact that short-circuit current increased from 1.5 ± 0.4 to 3.9 ± 0.8 μmol · h−1 · cm−2, together with the negative net Cl− flux, points to activation of active electrogenic chloride secretion. Subepithelial resistance increased from 7 ± 1 to 18 ± 2 Ω · cm2 due to subepithelial collagenous bands of 48 ± 8–μm thickness. Epithelial resistance was diminished from 44 ± 3 to 29 ± 2 Ω · cm2, and this was accompanied by a decrease in occludin and claudin-4 expression. Neither mucosal surface area nor apoptotic ratio was altered in collagenous colitis. Conclusions: Reduced net Na+ and Cl− absorption is the predominant diarrheal mechanism in collagenous colitis, accompanied by a secretory component of active electrogenic chloride secretion. The subepithelial collagenous band as a significant diffusion barrier is a cofactor. Down-regulation of tight junction molecules but not epithelial apoptoses is a structural correlate of barrier dysfunction contributing to diarrhea by a leak flux mechanism. GASTROENTEROLOGY 2002;123:433-443