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Microscopic colitis (MC) is a name used to describe a chronic diarrheal syndrome that is caused by inflammation in the large intestine. It is called "microscopic" colitis because the inflammation can be detected only with a microscope. During an endoscope procedure (colonoscopy or sigmoidoscopy), the colon looks normal. The presence or absence of a specific feature within the colonic inflammatory process as seen under the microscope (thickened collagen under the surface of the biopsy) has led to use of two other names for this syndrome: collagenous colitis and lymphocytic colitis. The symptoms and treatment of this syndrome are identical, regardless of whether the collagen in the biopsy is thick or normal.
The typical patient is a middle-aged woman; but it is seen in men, children as young as six and older people also. Possible initial misdiagnoses include stress, gastroenteritis, celiac sprue, lupus, or irritable bowel syndrome (IBS). It's not unusual for diagnosis to take several years, since microscopic colitis is the form of inflammatory bowel disease least familiar to doctors and often the last considered.
There does not seem to be an association with Crohn's disease, ulcerative colitis, or cancer. It does not appear to be contagious. Some patients report a close family member with the same diagnosis or with similar intestinal symptoms, and it appears there may be a hereditary tendency to get microscopic colitis.
Certain foods, especially high fiber, fat, milk products, spices, wheat and/or uncooked fruit and vegetables, may aggravate it. But, some patients tolerate any foods -- even when quite ill.
Approximately half of the patients with microscopic colitis report a sudden onset. They can pin down the exact day and location that symptoms started, often triggered by an initial bout with dysentery, giardia, or an undiagnosed intestinal illness.
One theory is that the inflammatory response is caused by a bacterium or a bacterial toxin. Another theory suggests this is an autoimmune disease, although that hasn't been conclusively established. A third suggests that non-steroidal anti-inflammatory drugs (NSAIDs, such as aspirin or ibuprofen) might be responsible or aggravate the symptoms in individuals predisposed to the disease by another mechanism. It may well turn out to be a combination of several of these factors.
This illness can come and go, with or without treatment, making it difficult to assess the effect of any treatment plan.
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GLOSSARY
Anti-inflammatory: Reducing inflammation by acting on body mechanisms, without directly acting on the cause of inflammation, e.g., glucocorticoids, aspirin.
Arthritis: Inflammation of a joint, usually accompanied by pain, swelling, and stiffness, and resulting from infection, trauma, degenerative changes, metabolic disturbances, or other causes. It occurs in various forms, such as bacterial arthritis, osteoarthritis, or rheumatoid arthritis. Osteoarthritis, the most common form, is characterized by a gradual loss of cartilage and often an overgrowth of bone at the joints.
Autoimmune Disease: One of a large group of diseases in which the immune system turns against the body's own cells, tissues and organs, leading to chronic and often deadly conditions. Examples include multiple sclerosis, rheumatoid arthritis, systemic lupus, Bright's disease and diabetes.
Bacteria: Microscopic germs. Some bacteria are "harmful" and can cause disease, while other "friendly" bacteria protect the body from harmful invading organisms.
Biopsy: Excision of tissue from a living being for diagnosis.
Cancer: Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.
Celiac Disease: (Gluten sensitivity) A digestive disease that damages the small intestine and interferes with absorption of nutrients from food. People who have celiac disease cannot tolerate a protein called gluten. Common symptoms include diarrhea, increased appetite, bloating, weight loss, irritability and fatigue. Gluten is found in wheat (including spelt, triticale, and kamut), rye, barley and sometimes oats.
Chronic: Usually Chronic illness: Illness extending over a long period of time.
Colitis: Inflammation of the colon.
Collagen: The primary protein within white fibers of connective tissue and the organic substance found in tendons, ligaments, cartilage, skin, teeth and bone.
Colon: The part of the large intestine that extends to the rectum. The colon takes the contents of the small intestine, moving them to the rectum by contracting.
Crohn's Disease: Chronic inflammatory disease of the gastrointestinal tract. The most common symptoms are abdominal pain, often in the lower right area, and diarrhea. Rectal bleeding, weight loss, and fever may also occur. Bleeding may be serious and persistent, leading to anemia.
Diarrhea: Excessive discharge of contents of bowel.
Dysentery: An inflammatory disorder of the lower intestinal tract, usually caused by a bacterial, parasitic, or protozoan infection and resulting in pain, fever, and severe diarrhea, often accompanied by the passage of blood and mucous.
Endoscope: Instrument for examining the interior of a hollow organ.
Fibromyalgia: (FMS): Originally named fibrositis, it is a mysteriously debilitating syndrome that attacks women more often than men. It is not physically damaging to the body in any way, but is characterized by the constant presence of widespread pain that often moves about the body. Fibromyalgia can be so severe that it is often incapacitating.
Gastroenteritis: Gastrointestinal tract inflammation; characterized by abdominal pain, nausea, diarrhea, vomiting; which may be caused by bacteria, parasites or a virus.
Immune System: A complex that protects the body from disease organisms and other foreign bodies. The system includes the humoral immune response and the cell-mediated response. The immune system also protects the body from invasion by making local barriers and inflammation.
Irritable Bowel Syndrome: (IBS) A condition that causes upset intestines for a long period of time. It is very unpleasant to the sufferer but tends to be harmless and usually does not lead to more serious complaints. The symptoms vary from person to person and from day to day. In order to be diagnosed with IBS, a person must have at least three of the following symptoms: pain in the lower abdomen; bloating; constipation; diarrhea or alternating diarrhea and constipation; nausea; loss of appetite; tummy rumbling; flatulence; mucous in stools; indigestion; constant tiredness; frequent urination; low back pain; painful intercourse for women.
NSAID: Non-steroidal anti-inflammatory drug.
Ulcerative Colitis: (Colitis ulcerosa): Ulceration of the colon and rectum, usually long-term and characterized by rectal bleeding or blood in the stool, frequent urgent diarrhea/bowel movements each day, abdominal pain.
Signs, symptoms & indicators of Microscopic Colitis (Collagenous Colitis / Lymphocytic Colitis):
