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Microscopic colitis

What is microscopic colitis?

Microscopic colitis is a term for several types of colitis, which results in long-term diarrhea. A distinction is made between collagen colitis, lymphocytic colitis and eosinophilic colitis.

Common for them all is that they are completely benign, transient, and not to be confused with the more severe forms of colitis as ulcerative colitis and Crohn's disease.

What causes microscopic colitis?

The cause is uncertain, but there are many indications that it may be microorganisms (bacteria, viruses, parasites), which trigger an abnormal immune reaction in the intestinal mucosa.

What are the symptoms of microscopic colitis?

Microscopic colitis usually begins suddenly, and results in watery diarrhea with no blood included. There may be stomach cramps, nocturnal diarrhea, weight loss and fatigue. There may be joint pain and signs of dehydration, due to the volume of diarrhea.

Microscopic colitis usually stagnates after a period of 6 to 36 months, but most patients have severe symptoms prompting medical treatment.

Who gets microscopic colitis?

Ten percent of patients with prolonged diarrhea have microscopic colitis. Women are affected 6 to 9 times more frequently than men, and usually after the age of 45.

It is a rare disease, only about 30 out of 10.000 people have microscopic colitis. In nearly half of patients with microscopic colitis, other diseases such as diabetes, metabolic disorders, rheumatic disorders, gluten allergy and asthma are present.

How is it diagnosed?

Microscopic colitis can only be diagnosed by colonoscopy, during which tissue samples are collected for microscopy.

You should also exclude more common causes of diarrhea, such as intestinal infections with bacteria, viruses and parasites. This requires that stool samples are submitted for testing. Other common causes of prolonged diarrhea may be due to gluten allergy (coeliac disease), milk allergy (lactose intolerance), and metabolic disorders. These conditions can be investigated in blood samples.

How is microscopic colitis treated?

Several drugs have shown to have some effect on microscopic colitis, but for most people, the effect is usually transient so symptoms may recur when treatment ends.

The most effective way to normalize bowel function in 80-100% of the cases is Entocort, a steroid medicament (synthetic corticosteroid - budesonide). Entocort is given in decreasing doses over 3 months. Entocort has very few side effects, because it is only absorbed in small quantities from the gut and is quickly disposed from the body.

Rheumatic drugs - the so-called NSAID drugs such as Ibuprofen, Ipren, Kodimagnyl may worsen diarrhea and should be avoided.

Over the counter agents such as Imodium may stop diarrhea temporarily and may be used in situations where you might not be able to go to the bathroom when needed (when travelling, in cinema, theater, etc.).

Should you change your diet?

Coffee, alcohol, hot/spicy foods, fatty foods dairy products and citrus fruits may worsen diarrhea for some patients, but there is no strong evidence that dietary changes can effectively eliminate diarrhea.

High fiber diet or fiber supplements such as HUSK (Psyllium husks), available at pharmacies, chemists and supermarkets absorb fluid in the intestine and may reduce diarrhea.

How are the long-term prospects?

Microscopic colitis is a benign disease that is treated medically. The condition resolves after a period of 6 to 36 months. There are no increased risk of bowel cancer and no evidence that the condition is contagious.