Microscopic Colitis

Making a Diagnosis

A microscopic colitis diagnosis is made after tissue samples taken during colonoscopy (or flexible sigmoidoscopy) are examined under a microscope. Collagenous colitis is characterized by a larger-than-normal band of protein called collagen inside the lining of the colon. The thickness of the band varies, so multiple tissue samples from different areas of the colon may need to be examined. In lymphocytic colitis, tissue samples show inflammation, with white blood cells known as lymphocytes between the cells that line the colon. In contrast to collagenous colitis, in lymphocytic colitis, there is no abnormality of the collagen.
 
People with collagenous colitis are most often diagnosed in their 50s, although some cases have been reported in adults younger than 45 years and in children ages 5 to 12. It is diagnosed more frequently in women than in men.
 
People with lymphocytic colitis are also generally diagnosed in their 50s. Both men and women are equally affected.
 

Treatment for Microscopic Colitis

Microscopic colitis treatment varies depending on the symptoms and severity of the case. The disease has been known to resolve spontaneously, but most patients have recurrent symptoms.
 
Lifestyle changes aimed at improving diarrhea are usually the first line of treatment. Recommended changes include:
 
  • Reducing the amount of fat in the diet
  • Eliminating foods that contain caffeine or lactose
  • Not using NSAIDs.
     
If lifestyle changes alone are not enough, medications are often used to control the symptoms of microscopic colitis.
 
Antidiarrheal medications (such as bismuth subsalicylate) and bulking agents (such as fiber supplements) can help reduce diarrhea. Anti-inflammatory medications, such as mesalamine, sulfasalazine, and steroids (including budesonide), reduce inflammation. Immunosuppressive agents, which reduce the autoimmune response, are rarely needed.
 
For extreme cases of microscopic colitis, bypass of the colon or surgery to remove all or part of the colon have been done on occasion. However, these surgeries are rarely recommended.
 
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