Microscopic Colitis

Microscopic colitis is an inflammatory disease of the colon that causes chronic diarrhea and sometimes abdominal pain. . It removes water from the undigested food, stores it and then eliminates it from the body through bowel movements. Crohn's disease and ulcerative colitis (two related conditions that are caused by abnormalities of the body's immune system in which the body is inappropriately making antibodies and chemicals that attack the colon) Collagenous colitis and lymphocytic colitis are also called microscopic colitis The colon is a tube-shaped organ that runs from the first part of the large bowel to the rectum. It does not appear to be contagious, but is sometimes hereditary.

Microscopic colitis occurs in up to one-third of patients with celiac sprue and should be considered in patients with continued diarrhea after institution of a gluten-free diet. Mild disease may be treated with antidiarrheal agents (loperamide, cholestyramine). NSAIDs should be discontinued. Microscopic colitis, which includes collagenous colitis and lymphocytic colitis , is characterized by chronic diarrhea caused by inflammation in the colon. It is not related to ulcerative colitis or to Crohn's disease, which are more severe forms of inflammatory bowel disease.

Microscopic colitis means there is no sign of inflammation on the surface of the colon when viewed with a colonoscopy or flexible sigmoidoscopy two tests that let a doctor look inside your large intestine. Patients undergoing either sigmoidoscopy or colonoscopy for unexplained diarrhea who have normal endoscopic findings should have biopsy samples taken to diagnose or rule out either form of microscopic colitis. There can be an association with other auto-immune disorders, such as thyroid disorders, diabetes and rheumatoid arthritis.

Types of Colitis

1. Lymphocytic colitis is characterised by increased lymphocytes in the lining of the colon.

2. Collagenous colitis is characterised by a thickening of the sub-epithelial collagen layer and increased lymphocytes in the lining of the colon.

Delayed release budesonide (Entocort) 9 mg/d for 6–8 weeks has been shown in several prospective controlled studies to induce clinical remission in more than 60–80% of patients and is well tolerated. After entering remission, clinical relapse occurs in 20–30% of patients within 3 years. Another type of microscopic colitis is lymphocytic colitis. In this case, biopsy samples reveal an increased number of lymphocytes, specialized white blood cells that fight infection and disease, within the lining of the colon. Lymphocytes may be seen in collagenous colitis, too, which somewhat blurs the distinction between the two conditions. A thickened collagen band isn't seen in lymphocytic colitis , though.

Cause of Microscopic Colitis

Here are the list of the possible cause of Microscopic Colitis:

• Nonsteroidal anti-inflammatory drugs (NSAIDs), antidepressants, ranitidine, carbamazepine, ticlopidine, and flutamide have been suspected in some cases of LC and CC, although the only report of a rechallenge has been with ranitidine
• Bacteria and their toxins, or a virus, may be responsible for causing inflammation and damage to the colon
• Increased mast cells in some LC patients might indicate that degranulation products could serve as a chemoattractant for inflammatory cells.
• About half of the patients can identify a specific time when the first episode occurred.
• Furthermore, it appears that colitis can cause the immune system to begin recognizing gluten as immunostimulatory and vice versa, gluten sensitivity can lead to colitis.

Symtoms of Microscopic Colitis

Some sign and symtoms related to Microscopic Colitis:

• The symptoms of collagenous colitis and lymphocytic colitis are the same�chronic, watery, non-bloody diarrhea
• In severe cases, this can lead to weakness and dehydration.
• An allergy to soy may produce gastrointestinal symptoms; it can also produce skin or respiratory reactions.
• Lactose intolerance (a type of disacharridase intolerance) is a common problem for celiac disease, particularly in those recently diagnosed in whom the intestinal lining has not yet healed with the use of diet therapy.
• If gluten sensitivity is present, many additional abdominal and other symptoms may be present
• These episodes may come on suddenly without any obvious explanation.

Treatment of Microscopic Colitis

Treatment with 5-ASAs (sulfasalazine, mesalamine) is reported to be effective in uncontrolled studies. Bismuth subsalicylate (two tablets four times daily) for 2 months is effective in many patients. Patients refractory to ASAs or bismuth may be treated with corticosteroids or, rarely, immunosuppressives. No single treatment is accepted as the standard, and measuring response is difficult. Often a trial of anti-diarrhoeals is followed by anti-inflammatory drugs. Drugs that have been used in the treatment of microscopic colitis include 5-aminosalicylic acid, bismuth, and steroids.

• Treatment usually starts with prescription anti-inflammatory medications, such as mesalamine (Rowasa or Canasa) and sulfasalazine (Azulfidine), in order to reduce swelling.
• First line: Loperamide (Imodium AD) or diphoxylate/atropine (Lomotil)
• If these measures are ineffective, treatment with sulfasalazine (Azulfidine) or other 5-aminosalicylic acid (ASA) preparations is recommended.
• Patients who respond to treatment, but experience a recurrence, will often respond again to the same previously effective medication.
• Avoid NSAIDs
• Trial of lactose elimination (just to eliminate the possibility that intolerance to lactose in milk is aggravating the diarrhea)
• Steroids, including budesonide (Entocort) and prednisone are also used to reduce inflammation. Steroids are usually only used to control a sudden attack of diarrhea. Long-term use of steroids is avoided because of side effects such as bone loss and high blood pressure.

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