What is Microscopic Colitis?

Microscopic colitis, a unique variation of colitis, is an inflammation of the lining of the colon (large intestine) that can cause chronic diarrhea. A routine colonoscopy may reveal a normal looking lining of the colon, yet under the light of a microscope, the biopsies will show inflammation.

Microscopic colitis comes in two forms: collagenous colitis, in which there is an abnormal layer of protein (collagen), and lymphocytic colitis, where instead of the collagen layer, you find white blood cells (lymphocytes) underneath the lining of the colon. Both have very similar presentations, symptoms, and treatments.

What Causes Microscopic Colitis?

It’s unclear what causes microscopic colitis, but researchers believe that it’s likely more than one reason, including infection with bacteria, viruses, parasites, Crohn’s disease, and ulcerative colitis.

Your risk of developing microscopic colitis increases with certain genetic predispositions, such as celiac disease. Some drugs, such as nonsteroidal anti-inflammatory drugs, like ibuprofen, SSRI type antidepressants, and antacids, may trigger or worsen microscopic colitis.

What are the Symptoms of Microscopic Colitis?

The most common symptom of microscopic colitis is chronic, non-bloody, watery diarrhea that persists months to years, and may come and go intermittently. Other signs may include:

  • Abdominal cramping, bloating, or pain
  • Weight loss
  • Nausea
  • Fecal incontinence
  • Dehydration

Women are more likely to be affected by microscopic colitis than men. During menopause, symptoms can worsen due to hormonal imbalances. Symptoms are most common in middle-aged adults.

What is the Treatment for Microscopic Colitis?

Treating microscopic colitis includes making lifestyle and medication changes that may relieve diarrhea. Dietary recommendations include reducing the amount of caffeine, lactose, and fat in your diet. Your doctor may also recommend using different medications to treat underlying conditions.

If symptoms persist, antidiarrheal medications may be recommended. In cases of severe diarrhea, corticosteroids may be prescribed to decrease inflammation and reduce the activity of the immune system.

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