Microscopic colitis - specialists and information

Leading Medicine Guide Editors
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Leading Medicine Guide Editors

Microscopic colitis is an intestinal inflammation that shows up at the cellular level. It therefore often remains inconspicuous in a colonoscopy. Diagnosis is usually only possible on the basis of a tissue sample (biopsy). The main symptoms of the disease are repeated watery diarrhea.

In this article you will learn more about the symptoms and treatment. You will also receive recommendations for suitable centers and specialists.

ICD codes for this diseases: K52.8

Recommended specialists

Article overview

What is microscopic colitis?

Medically, there are two different forms of microscopic colitis:

  1. Collagenous colitis
  2. Lymphocytic colitis

Around 1 in 1,000 people in this country suffer from this inflammatory bowel disease. It often affects women over the age of 65. Microscopic colitis occurs around five times more frequently in women than in men.

Mikroskopische KolitisMicroscopic colitis causes inflammation of the colon mucosa (colitis) @ David A Litman /AdobeStock

How does microscopic colitis develop?

The exact causes of the disease are still unknown. Experts suspect a multifactorial genesis. This means that the causes of the disease can be manifold or even complement each other.

Doctors are discussing genetic predispositions and errors in the immune response to the intestinal microbiome.

The exact causes of microbial colitis are unclear. However, studies show risk factors for inflammatory bowel disease.

Risk factors include, for example

  • Smoking
  • Long-term use of proton pump inhibitors (PPI)
  • Selective serotonin reuptake inhibitors
  • Pain medication from the group of non-steroidal anti-inflammatory drugs (NSAIDs)
  • Female gender
  • Older age (> 65 years)

The symptoms of microscopic colitis

The disease occurs repeatedly and then leads to watery and bloody diarrhea that can last up to 4 weeks. This is also the main symptom of microscopic colitis.

In addition, a nocturnal urge to defecate with fecal incontinence often develops . Those affected are literally unable to stop the diarrhea.

Other symptoms also occur, although these are generally largely unspecific.

These include

Diagnosis and differential diagnosis of microscopic colitis

As the changes manifest themselves particularly at the cellular level, the colonoscopy may be inconspicuous.

Koloskopie bei der mikroskopischen KolitisThe most important examination for detecting microscopic colitis iscolonoscopy@ Graphicroyalty /AdobeStock

This is why doctors usually diagnose "microscopic colitis" based on the clinical picture, symptoms and biopsy.

Samples are taken from several places in the intestine, as microscopic colitis is not evenly distributed throughout the intestine.

This procedure increases the chance of finding diagnostically useful material. Doctors refer to this as a "staged biopsy".

Depending on the findings, other intestinal diseases may also be considered, which the doctor would like to rule out in the differential diagnosis.

These include

Treatment options for microscopic colitis

The "European Microscopic Colitis Group" and the "United European Gastroenterology" published recommendations for the treatment of microscopic colitis in 2021.

They differentiate between:

  • Basic measures
  • Drug therapy and
  • Surgical measures

The basic measures are:

  • Abstaining from alcohol and smoking
  • Discontinuation (medically supervised) of certain medications such as painkillers and acid inhibitors

Drug therapy

The drug budesonide is suitable for relieving symptoms. The period is 6 to 8 weeks. If the symptoms disappear completely during this time (remission), no further maintenance therapy is necessary.

Alternatively, doctors can use loperamide or cholestyramine if the patient is intolerant to budesonide.

If problems persist, long-term treatment with low doses of budesonide is recommended. However, if budesonide is taken long-term, it is important to provide additional vitamin D and calcium. Otherwise bone softening(osteoporosis) may occur.

In severe cases, immunomodulators or biologics may also develop.

Surgical therapy

If medication does not help to control the disease sufficiently, surgery (ileostomy) is used in rare cases.

The prognosis for microscopic colitis

Microscopic colitis is easily treatable thanks to the available treatment options. However, as an inflammatory bowel disease, the disease has a recurring (relapsing) character. There is no increased risk of bowel cancer.

Who treats microscopic colitis?

The large group of inflammatory bowel diseases belongs in the experienced hands of gastroenterologists. You will therefore find experts for the treatment of microscopic colitis in designated gastroenterology centers or in your own practice.

To help you, we have compiled a list of proven microscopic colitis specialists and/or clinical centers above.

References

dccv.de/betroffene-angehoerige/medizinische-grundlagen/was-sind-mikroskopische-kolitiden/
flexikon.doccheck.com/de/Mikroskopische_Kolitis
Miehlke S et al., European guidelines on microscopic colitis: United European Gastroenterology and European Microscopic Colitis Group statements and recommendations. United European Gastroenterol J 2021; 9: 13–37 [Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8259259/pdf/UEG2-9-13.pdf; zuletzt aufgerufen am 14.01.2024]
rosenfluh.ch/arsmedici-2021-09/mikroskopische-kolitis-antworten-auf-praktische-fragen
springermedizin.de/chronisch-entzuendliche-darmerkrankungen/budesonid/erste-europaeische-leitlinie-zur-mikroskopischen-kolitis/18862970
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