Published online May 21, 2015. doi: 10.3748/wjg.v21.i19.6065
Peer-review started: October 28, 2014
First decision: November 14, 2014
Revised: December 3, 2014
Accepted: January 30, 2015
Article in press: January 30, 2015
Published online: May 21, 2015
Processing time: 205 Days and 12 Hours
Core tip: The pathophysiology of collagenous colitis remains poorly understood. We describe a patient with chronic, active collagenous colitis who either failed to achieve clinical remission or experienced adverse effects with all medications given; therefore the patient was treated with a temporary loop ileostomy. We analyzed cytokine protein production with Luminex assays in colonic biopsy tissues obtained before and during fecal stream diversion (FSD) and after intestinal continuity was restored. Because FSD leads to clinical and histological remission, this study protocol provided a unique opportunity to study cytokine dynamics during different stages of disease. We were thus able to demonstrate that FSD was followed by a decrease in the levels of nearly all cytokines and that the restoration of bowel continuity increased the levels of the proinflammatory cytokines interleukin IL-2, IL-21 and IL-23.