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Microscopic colitis is a kind of chronic inflammatory disorder of the colon or large intestine. It is referred to as “microscopic” since it can only be viewed using a microscope. The term “colitis” refers to inflammation of the colon, specifically the inner lining. This condition typically results in frequent, watery diarrhea.
Microscopic colitis has various subtypes, including collagenous colitis, lymphocytic colitis, and incomplete microscopic colitis. Collagenous colitis is distinguished by the buildup of protein or collagen in the colon tissue, forming a thick coating. Lymphocytic colitis, on the other hand, is marked by an elevated presence of white blood cells, specifically lymphocytes, in the colon tissue.
Microscopic colitis is a chronic illness that can exhibit intermittent periods of exacerbation and remission. It may be triggered by certain factors and may resolve without intervention. Despite being a chronic condition, it can often be managed effectively with medication. Additionally, all subtypes of microscopic colitis share the same symptoms, diagnostic testing, and treatment options.
Symptoms
Microscopic colitis symptoms might come and go at any time. Persistent watery diarrhea remains the most prevalent symptom associated with this condition, despite rare reports of individuals with microscopic colitis who do not experience this symptom. Other symptoms may include:
- Dehydration
- Nausea
- Fecal incontinence
- Stomachache, cramps, or bloating
- Unexplained loss of weight
To prevent complications and manage the condition effectively, it is advisable to seek medical advice if any signs or symptoms persist. Consulting with a healthcare professional is recommended in such cases.
Causes
Microscopic colitis has no definite cause. Several factors may be involved, such as:
- Medicines that can upset the intestinal lining.
- Bacteria and viruses that cause inflammation to the colon lining.
- Autoimmune disease wherein the immune system mistakenly attacks the body’s healthy tissues. Rheumatoid arthritis, celiac disease, and psoriasis are a few examples of autoimmune diseases that may be linked with microscopic colitis.
- Bile acid can irritate the colon lining when not adequately absorbed.
Risk factors
The following factors affect one’s risk of acquiring microscopic colitis:
- Age: It is prevalent in older people between the ages of 50 and 70.
- Sex: Some research suggests a link between postmenopausal hormone therapy and microscopic colitis. Thus, people who were assigned female at birth are more susceptible to microscopic colitis.
- Autoimmune disease: People with certain autoimmune illnesses, including celiac disease, thyroid disease, rheumatoid arthritis, type 1 diabetes, or psoriasis are at a higher risk.
- Genetics: Having a family medical history of irritable bowel syndrome is scientifically linked with microscopic colitis.
- Smoking: People aged 16 to 44 with smoking history are at higher risk of microscopic colitis.
- Use of certain drugs: Medications such as pain relievers, proton pump inhibitors, selective serotonin reuptake inhibitors, flutamide, carbamazepine, among others may raise the risk of microscopic colitis.
Diagnosis
When diagnosing microscopic colitis, the medical practitioner typically begins by reviewing the patient’s medical history, assessing symptoms, and enquiring about any medications they are currently taking. A physical examination may also be conducted. Other illnesses, including celiac disease, may need to be ruled out to determine the underlying cause of the symptoms.
The following tests may be required to confirm the diagnosis:
- Colonoscopy: During the procedure, the doctor will examine the inside of the colon using a colonoscope. The colonoscope is a long, flexible equipment with camera will be placed into the colon through the rectum. The camera transmits photos of the rectum and entire colon to an external monitor, where the doctor can study the intestinal lining. The physician also can introduce instruments through the tube in order to extract a sample of tissue, which is also known as a biopsy.
- Flexible sigmoidoscopy: During this procedure, the doctor examines the intestinal lining using a slender, flexible, illuminated tube known as sigmoidoscope. This enables the doctor to see the final 2 feet of the large intestine which covers the inside of the rectum and majority of the sigmoid colon. During the exam, a tissue sample can be also collected using the sigmoidoscope.
Cells in colon tissue have a different appearance under the microscope in both subtypes of microscopic colitis. To confirm the diagnosis, a colon tissue sample or biopsy is taken through a colonoscopy or flexible sigmoidoscopy.
In some cases, additional testing may be necessary to rule out other possible reasons of the symptoms. These tests may include:
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- Stool sample test: This is to eliminate possible causes of the symptoms particularly prolonged diarrhea.
- Blood test: This will detect anemia or infection.
- Upper endoscopy with biopsy: is performed to inspect the top part of your digestive tract. A long, thin tube with a camera at the end is used. This test can rule out celiac disease.
Treatment
Treatment for microscopic colitis vary based on the severity of the symptoms. Symptoms may appear and then disappear on their own. Sometimes, symptoms are managed successfully with dietary changes alone, while others may need to utilize medication on a more frequent or intermittent basis.
The treatment may include dietary and lifestyle adjustments, over the counter and prescription drugs, as well as surgery. Physicians normally take a step-by-step approach, beginning with the most basic, easily tolerated medicines.
- Diet and drug discontinuation: To alleviate chronic diarrhea, medical practitioners may recommend dietary modifications and medications, such as:
- Have a low-fat, low-fiber diet: A gastrointestinal soft diet, which consists of low fat and low fiber meals, to treat flare-ups may be recommended. Less fat and fiber in the diet means less work for the digestive system.
- Eliminating common food triggers: Some of the most prevalent trigger food items for microscopic colitis are alcohol, caffeine, gluten, dairy, sugar, and artificial sweeteners. Identifying the food trigger may require some trial and error as it is unique for everybody. Decreasing these foods and boosting anti-inflammatory foods may help manage symptoms.
- Stop taking any medications that may be causing the problems: In order to treat an underlying illness, a physician may prescribe an alternative medication.
- Medications: The common medications for microscopic colitis include:
- Anti-diarrheal medications: such as loperamide or bismuth subsalicylate
- Steroids: such as budesonide
- Bile acid blockers: such as cholestyramine/aspartame or cholestyramine, or colestipol
- Bulking agents: such as psyllium, can help your stool become firmer and slow its transit time.
- Anti-inflammatory medications: such as mesalamine to help manage colon inflammation
- Medications that suppress the immune system: such as mercaptopurine and azathioprine can assist reduce inflammation in the colon.
- Tumor necrosis factor (TNF) inhibitors: such as infliximab and adalimumab can reduce inflammation by suppressing tumor necrosis factor.
- Surgery: While it is an uncommon solution, surgical removal of some or all of the colon may be recommended if the symptoms are severe or other treatment methods and medications fail to provide relief from the symptoms. This option may be suggested by the physician.
