Medically speaking, there are two different forms of microscopic colitis:
- Collagenous colitis
- Lymphocytic colitis
About 1 in 1,000 people in this country develop this inflammatory bowel disease. It frequently affects women over the age of 65. Microscopic colitis occurs about five times more often in women than in men.
Microscopic colitis involves inflammation of the colon’s lining (colitis) @ David A Litman /AdobeStock
The exact causes of the disease remain unknown. Experts suspect a multifactorial origin. This means that the causes of the disease may be varied or even complementary.
Medical professionals are discussing genetic predispositions as well as abnormalities in the immune response to the gut microbiome.
The exact causes of microbial colitis are unclear. However, studies have identified risk factors for inflammatory bowel diseases.
Risk factors include, for example:
- Smoking
- Long-term use of proton pump inhibitors (PPIs)
- Selective serotonin reuptake inhibitors
- Pain medications from the nonsteroidal anti-inflammatory drug (NSAID) class
- Female gender
- Advanced age (> 65 years)
The condition recurs and leads to watery and bloody diarrhea that can last up to 4 weeks. This is also the primary symptom of microscopic colitis.
In addition, patients often develop a nocturnal urge to defecate accompanied by fecal incontinence. Those affected literally cannot hold back the diarrhea.
Furthermore, other symptoms may occur, though they are generally largely nonspecific.
These include:
Since the changes manifest primarily at the cellular level, a colonoscopy may appear normal.
The most important test for detecting microscopic colitis is colonoscopy @ Graphicroyalty /AdobeStock
For this reason, doctors typically diagnose “microscopic colitis” based on the clinical presentation, symptoms, and biopsy results.
Tissue samples are taken from several locations in the intestine, since microscopic colitis does not develop uniformly throughout the intestine.
This approach increases the likelihood of finding diagnostically useful material. Doctors refer to this as a “staged biopsy.”
Depending on the findings, other intestinal diseases may also be possible, which the doctor will want to rule out in the differential diagnosis.
These include:
The “European Microscopic Colitis Group” and “United European Gastroenterology” published recommendations for the treatment of microscopic colitis in 2021.
These recommendations are categorized as follows:
- Basic measures
- Medication, as well as
- Surgical measures
The basic measures are:
- Avoiding alcohol and smoking
- Discontinuing (under medical supervision) certain medications such as pain relievers and acid-suppressing drugs
Medication
The medication budesonide is effective for relieving symptoms. The treatment duration is 6 to 8 weeks. If the symptoms of the disease completely subside during this time (remission), no further maintenance therapy is necessary.
Alternatively, doctors may prescribe loperamide or cholestyramine if the patient is intolerant to budesonide.
For persistent problems, long-term treatment with low doses of budesonide is recommended. However, when taking budesonide long-term, it is important to take additional vitamin D and calcium supplements. Otherwise, bone loss (osteoporosis) may occur.
In severe cases, immunomodulators or biologics may also be prescribed.
Surgical Treatment
If medications are insufficient to adequately control the disease, surgery (ileostomy) may be performed in rare cases.
Microscopic colitis is highly treatable thanks to the available treatment options. However, as an inflammatory bowel disease, it tends to be recurrent. There is no increased risk of colorectal cancer.
The broad category of inflammatory bowel diseases falls under the expertise of gastroenterologists. You can therefore find experts in the treatment of microscopic colitis at specialized gastroenterology centers or in private practices.
To assist you, we have compiled a list of recognized specialists in microscopic colitis and/or clinical centers above.
What is microscopic colitis?
Microscopic colitis is an inflammatory disease of the large intestine that is only visible under a microscope. Microscopic colitis is a form of colitis characterized by chronic watery diarrhea. Although a colonoscopy may appear normal, microscopic colitis can be diagnosed histologically.
What forms of microscopic colitis are there?
The forms of microscopic colitis include collagenous colitis and lymphocytic colitis. Collagenous colitis and lymphocytic colitis differ in their histological features. In patients with lymphocytic colitis, an increased number of lymphocytes is found, whereas in collagenous colitis, a thickened collagen band is visible.
What are the typical symptoms of microscopic colitis?
The main symptom of microscopic colitis is chronic watery diarrhea without blood. Other symptoms of microscopic colitis may include weight loss or abdominal discomfort. Microscopic colitis is common in older patients, and symptoms often occur in episodes.
How is microscopic colitis treated?
Treatment for microscopic colitis usually involves budesonide. A daily dose of 9 mg of budesonide is considered the treatment of choice; the dose can later be reduced to 6 mg. After successful treatment, some patients may experience a recurrence of symptoms once the medication is discontinued.
What are the possible causes of microscopic colitis?
The exact causes of microscopic colitis are not fully understood. Risk factors include the use of certain medications and autoimmune processes. The development of microscopic colitis is also discussed in connection with chronic inflammatory bowel diseases, although the overall prognosis for microscopic colitis is favorable.
