About Microscopic Colitis
Microscopic colitis is a long-term (chronic) inflammatory bowel disease (IBD) that causes inflammation in the inner lining of the colon. It happens because the immune system reacts unusually. Unlike other types of IBD, microscopic colitis does not increase the risk of developing colon cancer. There are two types of microscopic colitis: lymphocytic colitis and collagenous colitis.
- Lymphocytic colitis: This type has an increased number of white blood cells in the colon lining.
- Collagenous colitis: The collagen layer (a protein layer under the colon lining) is thicker than normal.
Both types cause similar symptoms and respond to the same treatments. Microscopic colitis is diagnosed by examining colon tissue under a microscope, as this is the only way to detect the inflammation. It most commonly affects older adults and women, but anyone can develop it.
The root causes of microscopic colitis are still not fully understood, but several factors lead to its development. These include:
- Immune system reactions: Unusual immune system responses may cause inflammation in the colon.
- Medications: Certain medications have been linked with an increased risk of developing microscopic colitis. These include nonsteroidal anti-inflammatory drugs (NSAIDs), proton pump inhibitors (PPIs), selective serotonin reuptake inhibitors (SSRIs), hormone replacement therapy, and birth control pills (oral contraceptives).
- Problems with bile acid absorption: If the small intestines don’t take in enough bile acid, it can pass into the colon and possibly lead to microscopic colitis.
- Changes in gut bacteria: Researchers are studying whether changes in the balance of bacteria in the intestines might trigger or worsen microscopic colitis.
Non-modifiable risk factors for microscopic colitis cannot be changed or controlled. These include:
- Age: Being between 50 and 70 years old is linked with an increased risk.
- Gender: Women are more likely to develop microscopic colitis than men.
- Family history: Having a family history of irritable bowel syndrome (IBS) can increase the risk.
- Autoimmune diseases: Certain autoimmune diseases like type 1 diabetes, thyroid disease, rheumatoid arthritis, and celiac disease are linked to a higher risk.
Modifiable risk factors for microscopic colitis can be influenced or changed. This includes:
- Smoking: Studies suggest that smoking cigarettes may increase the chance of developing microscopic colitis.
It's important to note that while these factors have been linked with an increased risk of microscopic colitis, they do not mean that someone will develop the condition. If you have concerns about your risk or symptoms, it's best to talk with your healthcare professional for personalized advice and guidance.
The most common early symptom of microscopic colitis is long-term (chronic) diarrhea, which can happen 5 and 10 times a day and is usually watery. Other common symptoms that may occur with later stages, progression, or higher severity of microscopic colitis include:
- Abdominal cramps
- Bloating
- Nausea
- Feeling the urgent need to pass stool
- Unintentional weight loss: Losing weight without trying
- Fecal incontinence: Trouble controlling bowel movements, leading to accidental stool leakage
- Dehydration: Lack of enough water in the body, which can cause dry mouth, dizziness, and feeling very thirsty
- Acid reflux
- Headaches
- Muscle and joint pain
- Fatigue
It's important to note that symptoms can come and go, with times when controlling them are hard, followed by periods without symptoms. Some people may also experience remission, when symptoms lesson or go away, but later have relapses, where symptoms return or get worse. If you are having any of these symptoms, it is important to talk with your healthcare professional for the right diagnosis and treatment.
To diagnose microscopic colitis, doctors commonly perform the following exams, tests, and procedures:
- Medical history and physical exam: Your doctor will ask about your symptoms and medical history to get important information. During a physical exam they will check for pain or tenderness in your lower belly, look for signs of bloating, and check for dehydration (like dry skin or dizziness) from diarrhea. They may also look for any weight loss or signs of poor nutrition if symptoms have lasted awhile.
- Colonoscopy with biopsies: This involves using a long, flexible tube with a camera (a colonoscope), to look at the lining of the colon. Small tissue samples (biopsies) are taken from different parts of the colon to look at under a microscope for signs of microscopic colitis.
- Blood tests: These tests can help rule out other conditions that may have similar symptoms to microscopic colitis.
- Stool tests: These tests may be ordered to check for signs of infections or other conditions that can cause similar symptoms.
To determine the stage or severity of microscopic colitis, additional exams, tests, and procedures are usually not done. The diagnosis mainly relies on the results from a colonoscopy with biopsies. However, it's important to talk with your healthcare provider if you have any questions or concerns about the seriousness of the condition.
The goals of treatment for microscopic colitis are to reduce symptoms and help the person feel better overall. Here are some recommended treatments and how they work to achieve these goals:
- Removing trigger factors: This includes stopping smoking and staying away from certain medications that may make symptoms worse. By removing these factors, the inflammation in the colon can be reduced.
- Medication changes: Your doctor may suggest new or different medications to help control symptoms. Anti-inflammatory medications can reduce inflammation in the colon. Medications the calm the immune system may be used if your immune system is causing the swelling in the colon.
- Diet changes: Eating a low-fat, high-fiber diet can help improve your digestive system and ease symptoms. Identifying and staying away from foods that trigger symptoms can also make a difference.
- Lifestyle changes: Quitting smoking, regular exercise, and ways to handle or reduce stress can improve your health and relieve symptoms.
- Medications: Other medication options include:
- Bulking agents to slow down bowel movements
- Antidiarrheal medications to relieve symptoms
- Bile-blocking medications to reduce inflammation and diarrhea
- Steroids to reduce inflammation
- Surgery: In severe cases, surgery may be needed to remove part or all of the colon.
Remember, it's important to talk with your healthcare professional before making any medication or treatment changes.
Medication dosing may be affected by many factors, so it's best to seek personalized advice from your healthcare provider. Other side effects can occur, so it's important to discuss potential risks with your healthcare professional or refer to the information provided with your medication.