IBD

Microscopic Colitis

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Microscopic Colitis, Lymphocytic Colitis, Collagenous Colitis

  • See Also
  1. Chronic Watery Diarrhea
  2. Chronic Diarrhea
  • Epidemiology
  1. More common in older patients (age 50 years old and older)
  2. Causes 10% of Chronic Diarrhea cases
    1. Causes 10-15% of all Secretory Diarrhea
  3. Gender
    1. Women account for most cases
  4. Age 60 years is typical (<45 years in 25% of cases)
  • Risk Factors
  • Medications
  1. NSAID use for longer than 6 months
  2. Aspirin
  3. Statins
  4. Proton Pump Inhibitors
  5. Selective Serotonin Reuptake Inhibitors (SSRI)
  • Associated Conditions
  1. Irritable Bowel Syndrome
    1. Microscopic Colitis is present in 5-10% of Irritable Bowel Syndrome
  2. Celiac Disease
  • Symptoms
  1. Chronic Watery Diarrhea
    1. Secretory Diarrhea (Diarrhea day and night regardless of Fasting)
  2. Abdominal Pain
  3. Weight loss
  4. Arthralgias
  5. Fatigue
  • Labs
  1. Stool studies without microscopic blood or mucus
  • Associated Conditions
  1. Celiac Sprue (5% of cases)
  1. Normal gross appearance
  2. Biopsy of transverse colon (random biopsies) confirms diagnosis with one of two histologic patterns
    1. Lymphocytic Colitis
      1. Lamina propria with lymphocytic infiltrate
    2. Collagenous Colitis
      1. Subepithelial Collagen layer increased >10mm
  • Management
  1. Discontinue predisposing medications (esp. NSAIDs)
    1. Stop NSAIDs
    2. Stop Proton Pump Inhibitors (e.g. Omeprazole)
    3. Stop Statins
    4. Stop Selective Serotonin Reuptake Inhibitor
  2. Mild Symptoms
    1. Treat as Diarrhea predominant Irritable Bowel Syndrome
    2. Cholestyramine 4 grams qhs to 6 times daily
    3. Loperamide (Imodium) 2-4 mg four times daily prn (primarily before meals)
    4. Diphenoxylate
    5. Bismuth Subsalicylate
  3. Moderate Symptoms
    1. Budesonide AND
    2. Mild symptom management options
  4. Severe Symptoms
    1. Immunomodulators (6-Mercaptopurine, Methotrexate, Azathioprine, Infliximab)
  • References
  1. Abdo (2003) Can Fam Physician 49:1473-8 [PubMed]
  2. Gentile (2018) Gut Liver 12(3): 227-35 +PMID:28669150 [PubMed]
    1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5945253/
  3. Levison (1993) Gastroenterology 105(5): 1594-6 [PubMed]