Understanding Microscopic Colitis: Symptoms and Treatment

Microscopic colitis is a relatively common cause of chronic diarrhea, especially among older adults. Despite its prevalence, it often goes undiagnosed due to its subtle symptoms and the need for a biopsy to confirm the diagnosis.

It aims to shed light on microscopic colitis by discussing its symptoms, causes, diagnosis, and treatment options.

What is Microscopic Colitis?

Microscopic colitis is an inflammatory bowel disease (IBD) characterized by chronic, non-bloody diarrhea. It gets its name because the inflammation it causes is only visible under a microscope. There are two main types of microscopic colitis: collagenous colitis and lymphocytic colitis. Both types present similar symptoms but have distinct histological features.

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Collagenous Colitis

In collagenous colitis, a thick layer of collagen, a type of protein, builds up under the lining of the colon. This thickening can interfere with the colon's ability to absorb water, leading to diarrhea.

Lymphocytic Colitis

Lymphocytic colitis is characterized by an increased number of lymphocytes, a type of white blood cell, in the lining of the colon. This increase also leads to inflammation and chronic diarrhea.

Causes of Microscopic Colitis

The exact cause of microscopic colitis is unknown, but several factors may contribute to its development:

Medications: Certain medications, including nonsteroidal anti-inflammatory drugs (NSAIDs), proton pump inhibitors (PPIs), and selective serotonin reuptake inhibitors (SSRIs), have been linked to microscopic colitis.
Autoimmune Disorders: People with other autoimmune diseases, such as celiac disease or rheumatoid arthritis, are at higher risk.
Infections: Bacterial and viral infections may trigger the inflammation associated with microscopic colitis.
Genetics: A family history of IBD may increase the likelihood of developing microscopic colitis.

Symptoms of Microscopic Colitis

The most common symptom of microscopic colitis is chronic, watery diarrhea. Other symptoms may include:

Abdominal pain or cramps
Bloating
Nausea
Weight loss
Fatigue

These symptoms can vary in severity and may come and go, making the condition difficult to diagnose without a biopsy.

Microscopic Colitis vs. Ulcerative Colitis

It's important to differentiate microscopic colitis from other forms of colitis, such as ulcerative colitis. While both conditions are types of IBD, they have distinct characteristics:

Microscopic Colitis: Inflammation is only visible under a microscope and is limited to the colon's lining.
Ulcerative Colitis: Causes visible ulcers and inflammation throughout the entire colon and rectum, leading to bloody diarrhea.

Diagnosing Microscopic Colitis

Diagnosing microscopic colitis involves several steps:

Medical History and Physical Examination

Your doctor will start by taking a detailed medical history and performing a physical examination to rule out other potential causes of your symptoms.

Stool Tests

Stool tests can help identify infections or other conditions that might be causing diarrhea.

Colonoscopy and Biopsy

A colonoscopy allows your doctor to examine the inside of your colon. During the procedure, they will take small tissue samples (biopsies) from different parts of the colon. These samples are then examined under a microscope to look for signs of inflammation.

Pathology Outlines of Microscopic Colitis

The pathology of microscopic colitis involves specific microscopic changes in the colon's lining:

Collagenous Colitis: Thickened subepithelial collagen layer and chronic inflammation in the lamina propria.
Lymphocytic Colitis: Increased intraepithelial lymphocytes and chronic inflammation in the lamina propria.

These changes are not visible during a colonoscopy, which is why a biopsy is essential for diagnosis.

Treatment for Microscopic Colitis

Treatment for microscopic colitis aims to reduce inflammation and alleviate symptoms. The approach may include:

Medications

Anti-diarrheal medications: Loperamide can help control diarrhea.
Anti-inflammatory drugs: Budesonide, a corticosteroid, can reduce inflammation and is often the first-line treatment.
Immune system suppressors: In cases where other treatments fail, drugs that suppress the immune system, such as azathioprine, may be used.

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Dietary Changes

Some people find that certain foods exacerbate their symptoms. A low-fat, low-fiber diet may help manage diarrhea. Avoiding caffeine, alcohol, and artificial sweeteners can also be beneficial.

Discontinuing Triggering Medications

If a medication is suspected to be the cause, discontinuing it (under your doctor's guidance) may resolve the symptoms.

Probiotics

Though research is ongoing, some studies suggest that probiotics may help restore the natural balance of bacteria in the gut and alleviate symptoms.

Living with Microscopic Colitis

Living with microscopic colitis can be challenging, but there are ways to manage the condition effectively:

Regular Medical Follow-ups: Keep up with regular check-ups to monitor your condition and adjust treatment as needed.
Stay Hydrated: Chronic diarrhea can lead to dehydration. Drink plenty of fluids, and consider oral rehydration solutions if necessary.
Support Groups: Connecting with others who have microscopic colitis can provide emotional support and practical advice.

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