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Microdermabrasion - Microscopic Colitis (Lymphocytic Colitis and Collagenous Colitis)

Microscopic Colitis
(Lymphocytic Colitis and Collagenous Colitis)


  • What is colitis?
  • What diseases are not colitis?
  • What is microscopic colitis?
  • What causes microscopic colitis?
  • What are the symptoms of microscopic colitis?
  • How common is microscopic colitis and who is at risk?
  • When should I seek medical care for microscopic colitis?
  • How is microscopic colitis diagnosed?
  • What is the treatment for microscopic colitis?
  • What is the prognosis of microscopic colitis?
  • Can microscopic colitis be prevented?
  • Patient Discussions: Lymphocytic Colitis - Treatments
  • Patient Discussions: Lymphocytic Colitis - Cause
  • Find a local Gastroenterologist in your town

What is colitis?

Colitis means inflammation of the colon. The colon, also known as the large intestine or large bowel, constitutes the last part of the digestive tract. The colon is a long, muscular tube that receives undigested food from the small intestine. It removes water from the undigested food, stores the undigested food, and then eliminates it from the body through bowel movements. The rectum is the last part of the colon adjacent to the anus. The common symptoms of colitis include:

  • abdominal pain,
  • diarrhea, and
  • sometimes, rectal bleeding.

There are many different types of colitis with different causes. Some examples of colitis include:

  • infectious colitis caused by bacteria (such as shigella, Campylobacter, E. coli, and C. difficile)
  • infectious colitis caused by a virus (such as cytomegalovirus [CMV])
  • radiation colitis (such as following treatment with radiation for prostate cancer)
  • ischemic colitis (such as blockage of an artery in the colon by a blood clot. If the blood clot interrupts the flow of blood to a segment of the colon, the result is inflammation of that segment and, sometimes, even death [gangrene] of the segment)
  • Crohn's disease and ulcerative colitis (two related conditions that are caused by abnormalities of the body's immune system in which the body is inappropriately making antibodies and chemicals that attack the colon). Crohn's disease and ulcerative colitis are also referred to as inflammatory bowel disease (IBD).

Infectious, radiation, ischemic, ulcerative, and Crohn's colitis all have visible abnormalities of the inner lining of the colon. These abnormalities include edema (swelling of the lining), redness, bleeding from the lining with gentle rubbing (friability), and ulcers. These abnormalities can be seen during either colonoscopy (examination of the entire colon using a long flexible viewing tube) or flexible sigmoidoscopy (examination of the rectum and the sigmoid colon - the segment of the colon closest to the rectum).

Edema and inflammation of the colon's lining interferes with the absorption of water from the undigested food, and the unabsorbed water exits the rectum as diarrhea. Pus and fluid also are secreted into the colon and add to the diarrhea. The redness, bleeding from the lining with gentle rubbing (friability), and ulcerations in the lining of the colon contribute to rectal bleeding.

Picture of Large Intestine (Colon) Anatomy

 

What diseases are not colitis?

Individuals with irritable bowel syndrome (IBS) do not have colitis, even though this condition is sometimes referred to as having "spastic colitis." These individuals may have symptoms that mimic colitis such as diarrhea, abdominal pain, and mucous in stool. Nevertheless, there is no inflammation of the colon (not even microscopic colitis) in patients with IBS. The cause of symptoms in IBS is not clearly known; it may be caused by either abnormal motility (abnormal contractions) of the intestinal muscles or abnormally sensitive nerves in the intestines (visceral hypersensitivity).

What is microscopic colitis?

Microscopic colitis refers to inflammation of the colon that is only visible when the colon's lining is examined under a microscope. The appearance of the inner colon lining in microscopic colitis is normal by visual inspection during colonoscopy or flexible sigmoidoscopy. The diagnosis of microscopic colitis is made when a doctor, while performing colonoscopy or flexible sigmoidoscopy, takes biopsies (small samples of tissue) of the normal-appearing lining, and then examines the biopsies under a microscope.

There are two types of microscopic colitis: 1) lymphocytic colitis and 2) collagenous colitis.

  1. In lymphocytic colitis, there is an accumulation of lymphocytes (a type of white blood cell) within the lining of the colon.
  2. In collagenous colitis, there is an additional layer of collagen (scar tissue) just below the lining.

Some experts believe that lymphocytic colitis and collagenous colitis represent different stages of the same disease.

The inflammation and the collagen probably interfere with absorption of water from the colon, and cause the diarrhea.

Medical Author:
Medical Editor:

 

 

In this Article

  • What is colitis?
  • What diseases are not colitis?
  • What is microscopic colitis?
  • What causes microscopic colitis?
  • What are the symptoms of microscopic colitis?
  • How common is microscopic colitis and who is at risk?
  • When should I seek medical care for microscopic colitis?
  • How is microscopic colitis diagnosed?
  • What is the treatment for microscopic colitis?
  • What is the prognosis of microscopic colitis?
  • Can microscopic colitis be prevented?
  • Find a local Gastroenterologist in your town

What causes microscopic colitis?

The cause(s) of microscopic colitis is unknown. Some doctors suspect that microscopic colitis is an autoimmune disorder similar to the autoimmune disorders that cause chronic ulcerative colitis and Crohn's disease.

One study has implicated long term (longer than 6 months) use of nonsteroidal antiinflammatory drugs (NSAIDs) as a cause of microscopic colitis. Some individuals' diarrhea improves after stopping the NSAIDs.

What are the symptoms of microscopic colitis?

The primary symptom of microscopic colitis is chronic, watery diarrhea. Individuals with microscopic colitis can have diarrhea for months or years before the diagnosis is made. Typically, the symptoms begin very gradually and are intermittent in nature with periods when the person feels well, followed by bouts of chronic diarrhea. This chronic diarrhea of microscopic colitis is different from the acute diarrhea of infectious colitis, which typically lasts only days to weeks. Some individuals with microscopic colitis also may experience mild abdominal cramps and pain. Blood in the stool is unusual.

How common is microscopic colitis and who is at risk?

The prevalence of microscopic colitis in the U.S. is not clearly known. It is estimated that 10% to 20% of persons with chronic diarrhea may have microscopic colitis. It is this author's experience, that the condition is becoming more common in recent years. It is not clear, however, whether there is an actual increase in the frequency of microscopic colitis or whether doctors are just better at diagnosing it.

Microscopic colitis most commonly occurs in middle aged to elderly patients and is more common among women than men.

When should I seek medical care for microscopic colitis?

A person should seek medical care if the diarrhea lasts for more than 2 weeks or is accompanied with symptoms such as weight loss, fatigue, and abdominal pain.

Medical Author:
Medical Editor:

 

 

In this Article

  • What is colitis?
  • What diseases are not colitis?
  • What is microscopic colitis?
  • What causes microscopic colitis?
  • What are the symptoms of microscopic colitis?
  • How common is microscopic colitis and who is at risk?
  • When should I seek medical care for microscopic colitis?
  • How is microscopic colitis diagnosed?
  • What is the treatment for microscopic colitis?
  • What is the prognosis of microscopic colitis?
  • Can microscopic colitis be prevented?
  • Find a local Gastroenterologist in your town

How is microscopic colitis diagnosed?

The diagnosis of microscopic colitis is made by performing biopsies from different regions of the colon during colonoscopy or sigmoidoscopy.

The abnormalities of the colon's lining in microscopic colitis occur in a patchy distribution (areas of normal lining may coexist adjacent to areas of abnormal lining). For this reason, multiple biopsies should be taken from several different regions of the colon in order to accurately make a diagnosis.

The patchy nature of microscopic colitis also is the reason why flexible sigmoidoscopy often is inadequate in diagnosing the condition because the abnormalities of microscopic colitis may be absent from the sigmoid colon (the colonic segment that is closest to the rectum and is within the reach of a sigmoidoscope) in 30% to 40% of the patients with microscopic colitis.

Thus, biopsies of other regions of the colon accessible only with colonoscopy may be necessary for diagnosing microscopic colitis.

What is the treatment for microscopic colitis?

The treatment of microscopic colitis has not been standardized because there have not been adequate large scale, prospective, placebo controlled treatment trials. The following strategies are safe and may relieve diarrhea in some patients:

  • Avoid nonsteroidal antiinflammatory drugs (NSAIDs)
  • Trial of lactose elimination (just to eliminate the possibility that intolerance to lactose in milk is aggravating the diarrhea)
  • Antidiarrhea agents such as loperamide (Imodium) or diphenoxylate and atropine (Lomotil)
  • Bismuth subsalicylate such as Pepto-Bismol
  • budesonide (Entocort EC)
  • 5-ASA (mesalamine) compounds such as Asacol, Pentasa, or Colazal
 

Controlled trials showed that budesonide (Entocort, a poorly absorbed steroid) is effective in controlling diarrhea in more than 75% of the patients with collagenous colitis, but the diarrhea tends to recur soon after stopping Entocort.

Though data supporting their use is lacking, some doctors may use medications that potently suppress the immune system such as azathioprine (Imuran, Azasan) and 6-mercaptopurine in patients with severe microscopic colitis that is unresponsive to other treatments.

Medical Author:
Medical Editor:

 

 

In this Article

  • What is colitis?
  • What diseases are not colitis?
  • What is microscopic colitis?
  • What causes microscopic colitis?
  • What are the symptoms of microscopic colitis?
  • How common is microscopic colitis and who is at risk?
  • When should I seek medical care for microscopic colitis?
  • How is microscopic colitis diagnosed?
  • What is the treatment for microscopic colitis?
  • What is the prognosis of microscopic colitis?
  • Can microscopic colitis be prevented?
  • Find a local Gastroenterologist in your town

Can microscopic colitis be prevented?

Since the cause of microscopic colitis is not known, no advice can be provided about preventing this disease.

What is the prognosis of microscopic colitis?

The long term prognosis (course) of microscopic colitis is not clear. In approximately two-thirds of the patients with microscopic colitis, the diarrhea resolves spontaneously after several years. The remaining one-third of the patients experience persistent or intermittent diarrhea for many years (possibly indefinitely).

Medical Author:
Medical Editor:

 

 

In this Article

  • What is colitis?
  • What diseases are not colitis?
  • What is microscopic colitis?
  • What causes microscopic colitis?
  • What are the symptoms of microscopic colitis?
  • How common is microscopic colitis and who is at risk?
  • When should I seek medical care for microscopic colitis?
  • How is microscopic colitis diagnosed?
  • What is the treatment for microscopic colitis?
  • What is the prognosis of microscopic colitis?
  • Can microscopic colitis be prevented?
  • Find a local Gastroenterologist in your town

Can microscopic colitis be prevented?

Since the cause of microscopic colitis is not known, no advice can be provided about preventing this disease.

What is the prognosis of microscopic colitis?

The long term prognosis (course) of microscopic colitis is not clear. In approximately two-thirds of the patients with microscopic colitis, the diarrhea resolves spontaneously after several years. The remaining one-third of the patients experience persistent or intermittent diarrhea for many years (possibly indefinitely).

Medical Author:
Medical Editor:

 

 

In this Article

  • What is microsporidiosis? What causes the disease?
  • How are microsporidia transmitted?
  • What symptoms does microsporidiosis cause?
  • How is microsporidiosis diagnosed?
  • How is microsporidiosis treated?
  • How is microsporidiosis prevented?
  • Microsporidiosis At A Glance

How is microsporidiosis diagnosed?

There are several tests available to diagnose microsporidia infection. Microscopic examination of stained samples of body fluids, primarily fecal samples, allows for rapid diagnosis, although the exact species of microsporidia may not be identified. Urine samples can also be used to detect spores when the kidney and/or bladder are involved.

A powerful microscope, called a transmission electron microscope, is needed to identify the species of microsporidia. However, this form of testing is expensive, and it is not available for routine use in all laboratories.

Other methods, such as immunofluorescence assays and polymerase chain reaction (PCR) testing, can also identify microsporidia infection in the research-laboratory setting.

Finally, blood tests and imaging studies can also assist in detecting microsporidiosis.

How is microsporidiosis treated?

The treatment of microsporidiosis is generally achieved with medications and supportive care. Depending on the site of infection and the microsporidia species involved, different medications are utilized. The most commonly used medications for microsporidiosis include albendazole (Albenza) and fumagillin.

For patients with diarrhea, intravenous fluid administration and electrolyte repletion may be necessary. Dietary and nutritional regimens may also assist with chronic diarrhea. Finally, improvement of immune system function with antiretroviral therapy in HIV-infected individuals may also lead to improvement of symptoms.

How is microsporidiosis prevented?

For patients with immune-system deficiency, frequent hand washing and limiting exposure to animals suspected of being infected with microsporidia is recommended.

 

Microsporidiosis At A Glance
  • Microsporidiosis is a disease that is caused by small parasites called microsporidia.
  • Generally, microsporidia do not cause disease in healthy people but rather in people with immune system deficiency.
  • Microsporidiosis can cause chronic diarrhea, kidney disease, and infection of the sinuses and eyes.
  • Diagnosing microsporidiosis requires laboratory testing.
  • Treatment of microsporidiosis requires medications and supportive care.

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