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.
Medically, there are two different forms of microscopic 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.
Microscopic colitis causes inflammation of the colon mucosa (colitis) @ David A Litman /AdobeStock
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
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
As the changes manifest themselves particularly at the cellular level, the colonoscopy may be inconspicuous.
The 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
The "European Microscopic Colitis Group" and the "United European Gastroenterology" published recommendations for the treatment of microscopic colitis in 2021.
They differentiate between:
The basic measures are:
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.
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.
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.
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