Microscopic Colitis

Microscopic colitis is an inflammatory disease of large intestine (colon) characterized by chronic watery diarrhea. The inflammations in the colon can only be detected through microscopic evaluation, hence the name microscopic colitis.

Microscopic colitis is of two types:

• collagenous colitis
• lymphocytic colitis.

Collagenous colitis is a condition characterized by build-up of a thick layer of collagen (a type of protein) in the colon tissue while lymphocytic colitis is characterized by an increased number of white blood cells (lymphocytes) in the colon tissue.

It’s not clear if these two kinds are separate conditions or different stages of the same condition. The symptoms, diagnosis and treatment of both kinds are similar.

The symptoms may be often “on” or “off”. Medications are prescribed if the symptoms don't subside on their own. 

The common signs and symptoms of microscopic colitis are:

• Chronic watery diarrhea
• Abdominal pain or cramps
• Reduced body weight
• Nausea
• Inability to control your bowel movements (fecal incontinence)

When to see a Doctor?

Visit your doctor if you have watery diarrhea than lasts more than few days.

The cause of inflammation of colon in microscopic colitis is not understood. Some believe that inflammation may occur due to:

• Medications that irritate the lining of the colon
• Bacterial toxins that irritate the lining of the colon
• Viruses that elicit inflammatory response
• Autoimmune disease, such as rheumatoid arthritis or celiac disease, that occurs when your body's immune system attacks healthy tissues.

Making a diagnosis of microscopic colitis is done by performing several tests.

It is important to be well prepared before visiting your doctor.

How to prepare yourself for the visit?

Getting prepared for the visit can optimize the therapy and help make the visit more fruitful. You may:

• List out all the symptoms along with their progression.
• Write down your key medical information.
• Write down in detail about your diet.
• Write down the names of all your medications, vitamins or supplements.

Make a list of the questions to ask your doctor. Some typical questions can be:

• What could be possible causes of my condition?
• Is my condition temporary or chronic?
• Do I need any tests?
• What are the treatments options and side effects of each option?
• Will surgery provide complete recovery?
• Do I need to follow any dietary restrictions?

What your doctor wants to know?

A clear talk with your doctor can optimize the therapy and improve the outcomes. Prepare yourself to answer some essential questions from your doctor. Your doctor might ask you typical questions like:

• When did you first notice the symptoms?
• Do the symptoms occur regularly or occasionally?
• How many loose motions you have in a day?
• Do your symptoms include abdominal cramps and nausea?
• Have you noticed blood in your stools?
• Have you lost some pounds since you started noticing the symptoms?
• Have you traveled recently?
• Have you been hospitalized or taken antibiotics in the last few months?
• Are you taking any medications?
• What are the key ingredients of you daily diet?
• How often do you use caffeine or alcohol?
• Have you been diagnosed with celiac disease? If so, is your diet gluten-free?
• Do you have diabetes or thyroid disease?
• Does anything improve or worsen your symptoms?

What you can do in the meantime?

Try following measures to get relief from diarrhea:

• Eat plain, low-fat foods.
• Avoid dairy products, spicy foods, caffeine and alcohol.

Physical examination along with your medical history can help to identify the cause of diarrhea. Other medical conditions, such as celiac disease or rheumatic arthritis (an autoimmune disease), may also cause diarrhea. Aspirin and ibuprofen are associated with increased risk of microscopic colitis.

Following test may be used to diagnose microscopic colitis:

• Stool sample analysis to determine whether diarrhea is caused by infection.
• Blood test or upper endoscopy with biopsy may be done to ensure that diarrhea is not caused by celiac disease. Endoscopy is a non-surgical procedure in which a long, thin tube with a camera on the end is guided into the upper part of your digestive tract to examine it. A tissue sample (biopsy) may be removed for analysis in the laboratory.
• Colonoscopy or flexible sigmoidoscopy with biopsy is done rule out other intestinal disorders. Both tests use a long, thin tube with a camera on the end to examine the interior of your colon. The colons of people with microscopic colitis may also appear normal. A biopsy can be obtained during colonoscopy or flexible sigmoidoscopy and viewed under microscope to identify microscopic colitis.

Microscopic colitis requires treatment when symptoms are persistent or severe. Treatment options include:

• Diet and medication changes: Changes in diet and medication can relieve chronic diarrhea. You may be recommended to:

1. Eat plain and a low-fat food.
2. Avoid fiber in your diet.
3. Stop taking medicine that might cause diarrhea

• Medications: Medications are recommended if signs and symptoms are persistent. Your doctor may suggest following medications:

1. Anti-diarrheal medications
2. Medications that bind to bile acids
3. Steroid or anti-inflammatory medications to reduce swellings in your colon
4. Immune suppressing drugs that suppress the immune system and eventually reduce inflammation in the colon

• Surgery: Surgery is reserved for severe microscopic colitis, and those unresponsive to medications. Either a part of colon or entire colon is removed. Surgery, a rare treatment for microscopic colitis, is performed only when other causes of diarrhea have been ruled out.

To relieve diarrhea associated with microscopic colitis, following lifestyle modifications can be helpful:

• Drink plenty of fluid specially water. Fluid with electrolytes (sodium and potassium) can also help.
• Avoid drinks which worsen your symptoms. Avoid drinks that are high in sugar, contain caffeine or alcohol.
• Eat bland food. Plain foods are easy to digest.
• Avoid foods that has high amount of fiber. Avoid spicy, fatty or fired foods which can aggravate your symptoms
• Eating several small meals are more beneficial than a few large meals

There are several risks associated with microscopic colitis, which include:

• Age and gender: Individuals, especially female, aged 50 to 70 are at an increased risk of developing microscopic colitis.
• Autoimmune disorder: People with autoimmune disorders, such as celiac disease, thyroid disease or rheumatoid arthritis, may have microscopic colitis.
• Smoking: According to recent study, you are at increased risk if you smoke and are aged between 16 and 44.
• Medications: People taking medications like aspirin, acetaminophen, ibuprofen, gastric acid reducing drugs, acarbose, ranitidine, selective serotonin reuptake inhibitors like sertraline, carbamazepine are likely to develop microscopic colitis.