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Microscopic Colitis: Collagenous Colitis and Lymphocytic Colitis

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Microscopic Colitis: Collagenous Colitis and Lymphocytic Colitis Microscopic Colitis: Collagenous Colitis and Lymphocytic Colitis National Digestive Diseases Information Clearinghouse What is microscopic colitis? The term bowel refers to any part of the small or large intestine. The large intes- Microscopic colitis is inflammation of the tine includes the colon and the rectum, and bowel that is only visible using a microscope. together they are about 5 feet long. The Microscopic colitis is a type of inflammatory U.S. Department small intestine can be 12 to 20 feet long. bowel disease (IBD), which refers to a group of Health and Colitis means inflammation of the colon. Human Services of conditions that causes inflammation in the Microscopic colitis is inflammation of the bowel due to an excessive build-up of white colon and rectum. NATIONAL blood cells in the bowel lining. Microscopic INSTITUTES OF HEALTH colitis is less severe than other types of IBD because it does not lead to cancer and rarely What are collagenous colitis requires surgery. However, microscopic and lymphocytic colitis? colitis can cause considerable pain and Microscopic colitis has two main forms: discomfort. collagenous colitis and lymphocytic colitis. The symptoms of and treatment for both are identical. Some scientists believe the two forms may be different presentations of the same disease. Slight differences in the way intestinal tissues appear when seen with a microscope set them apart. In both forms, an increase in white blood cells can be seen within the intestinal epithelium—the layer of Stomach Liver cells that lines the intestine. Increased white blood cells are a sign of inflammation. But with collagenous colitis, the layer of collagen Colon (shaded) beneath the epithelium appears thicker than normal. Collagen is a structural protein in bones and cartilage. In the intestines, col- lagen anchors the intestinal epithelium to underlying layers of tissue. The thicker col- lagen layer seen with collagenous colitis may result from inflammation. Rectum Small intestine Anus Microscopic colitis affects the colon and rectum. Who gets microscopic • nausea colitis? • weakness Microscopic colitis can affect anyone but is • fecal incontinence—inability to control more common in people ages 45 and older. a bowel movement Rates of microscopic colitis are similar to other forms of IBD, affecting about nine What causes microscopic people in 100,000.1 Although microscopic colitis affects both men and women, col- colitis? lagenous colitis is much more common in The cause of microscopic colitis is unknown. women. Many scientists believe it is an abnormal immune response triggered by something in What are the symptoms of the gastrointestinal (GI) tract—the large, muscular tube that extends from the mouth microscopic colitis? to the anus and digests food. Normally, the Chronic watery and nonbloody diarrhea is immune system is triggered by germs, but the main symptom of microscopic colitis. sometimes it reacts to harmless bacteria, pol- Episodes of diarrhea can last for weeks, len, food, or even the body’s own cells. The months, or years. Most cases are interrupted belief that something in the GI tract causes by similarly long periods of remission—times microscopic colitis is supported by evidence when diarrhea goes away. that the colon, when empty for a long time, recovers from inflammation. Keeping the Scientists believe diarrhea associated with colon empty is accomplished through a surgi- microscopic colitis is caused by the intesti- cal procedure called an ileostomy, which nal epithelium’s reduced ability to absorb diverts digestive waste away from the colon electrolytes—salts and minerals in the to an opening in the abdomen. The belief is body. The resulting electrolyte imbalance further supported by the fact that inflamma- decreases the colon’s ability to absorb fluid tion returns when the ileostomy is reversed and increases fluid secretion into the colon. and the normal digestive route through the Other common symptoms of microscopic colon is restored. colitis include Scientists believe one’s genes may make a • abdominal cramps or pain person more likely to develop microscopic colitis. Although a gene unique to micro- • abdominal bloating scopic colitis has yet to be found, dozens Less common symptoms of microscopic have been linked to other forms of IBD. colitis include • mild weight loss • dehydration 1Pardi DS, Loftus EV, Jr., Smyrk TC, et al. The epidemiology of microscopic colitis: a population based study in Olmsted County, Minnesota. Gut. 2007;56(4):504–508. 2 Microscopic Colitis: Collagenous Colitis and Lymphocytic Colitis Scientists have proposed several possible How is microscopic colitis substances that might trigger microscopic colitis. diagnosed? Microscopic colitis can only be diagnosed by Harmful and harmless bacteria. Some examining intestinal tissue removed during people get microscopic colitis after being colonoscopy or flexible sigmoidoscopy— sick with certain harmful bacteria, including procedures that use a lighted, flexible scope Yersinia enterocolitica, Campylobacter jejuni, to see inside the colon and rectum. Before and Clostridium difficile. Other people test colonoscopy or flexible sigmoidoscopy, the negative for these and other harmful bacte- doctor will rule out other conditions that ria, but their condition improves with antibi- cause diarrhea by asking questions about otic treatment, suggesting normally harmless symptoms and performing tests on blood bacteria in the colon may trigger microscopic and stool to look for signs of infection. colitis in some people. During colonoscopy, the doctor can rule out Medications. No medications have been even more conditions by looking at the lin- proven to cause microscopic colitis but ing of the colon. If the colon lining appears several have been linked to it, including normal, the doctor may suspect microscopic • acarbose (Prandase) colitis and will remove small pieces of tissue using tools passed through the scope. The • aspirin process of removing tissue is called biopsy. • lansoprazole (Prevacid) Because inflammation from microscopic colitis can occur in patches, the doctor will • nonsteroidal anti-inflammatory drugs biopsy several areas of the colon. After • ranitidine (Zantac) tissue has been collected, a pathologist—a doctor trained to diagnose diseases based on • sertraline (Zoloft) tissue appearance—examines the tissue with • ticlopidine (Ticlid) a microscope. Food. Certain foods appear to trigger micro- scopic colitis in some people. Although no specific foods have been identified, following a caffeine- or lactose-free diet sometimes improves symptoms. 3 Microscopic Colitis: Collagenous Colitis and Lymphocytic Colitis How is microscopic colitis treated? Points to Remember Treatment for microscopic colitis often • Microscopic colitis is inflamma- begins with eliminating medications with tion of the bowel that is only visible suspected links to microscopic colitis and using a microscope. cutting out foods that can make diarrhea • Microscopic colitis has two main worse, including foods containing caffeine, forms: collagenous colitis and high-fat foods, and dairy products. lymphocytic colitis. Antidiarrheal medications such as bismuth • Common symptoms of microscopic subsalicylate (Pepto-Bismol) and loperamide colitis include watery and non- (Immodium) are effective for some patients. bloody diarrhea, abdominal cramps or pain, and bloating. Less com- If diarrhea persists, medications called cor- mon symptoms include mild weight ticosteroids may help, including prednisone loss, dehydration, nausea, weak- and budesonide (Entocort). Corticosteroids ness, and fecal incontinence. have many potential side effects including insomnia, fluid retention, and mood swings. • Many scientists believe microscopic Budesonide has fewer side effects than other colitis is an abnormal immune corticosteroids and has been shown to be response triggered by something effective for treating microscopic colitis. in the gastrointestinal tract such as bacteria, medication, or food. Other medications used to treat microscopic colitis include mesalamine and cholestyr- • Microscopic colitis can only be amine (Questran). diagnosed by examining intes- tinal tissue removed during colonoscopy or flexible What is the treatment sigmoidoscopy—procedures that outlook for people with use a lighted, flexible scope to see microscopic colitis? inside the colon and rectum. People with microscopic colitis generally • Microscopic colitis is treated by achieve relief through treatment, although eliminating certain medications relapses can occur. Some patients require and foods and by taking medi- long-term therapy because they experience cations to control diarrhea and prompt relapse when treatment is stopped. inflammation. Unlike other forms of IBD, microscopic • People with microscopic colitis colitis usually does not progress to other generally achieve relief through IBD-related problems, such as arthritis, treatment, although relapses can bowel obstruction, or colon cancer. occur. • Unlike other forms of IBD, micro- scopic colitis usually does not progress to other IBD-related problems, such as arthritis, bowel obstruction, or colon cancer. 4 Microscopic Colitis: Collagenous Colitis and Lymphocytic Colitis Hope through Research Acknowledgments The National Institute of Diabetes and Publications produced by the Clearinghouse Digestive and Kidney Diseases (NIDDK) are carefully reviewed by both NIDDK conducts and supports research into many scientists and outside experts. This publica- kinds
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