Microscopic Colitis

Microscopic Colitis

What is Microscopic Colitis?

Microscopic colitis is a chronic condition that involves the digestive system, particularly the large intestine or colon. This condition primarily results to watery diarrhea and stomach discomfort. This inflammation-causing disease has two types, the lymphocytic colitis and the collagenous colitis. This is called microscopic colitis because of its physical presentation where inflammation of the colon can only be seen with the use of a microscope. If we are to view the lining of the colon with the visible eye, it would appear normal.

Those at risk for developing microscopic colitis are people aged 45 and above. In an epidemiological study, it has been noted that about 10% to 20% of reported cases of those who suffer from chronic diarrhea is caused by microscopic colitis. Men and women are equally affected by this bowel disease. However, collagenous colitis has been found more common in women than in men.

In order to properly diagnose which type of microscopic colitis the patient is suffering, meticulous procedures are performed. A colonoscopy is done in order to take samples from the inner lining of the colon which will be sent for analysis or biopsy. In observation, the areas affected of the inflammation arise in patches. In order to rule out other possible causes of diarrhea, stool examination is also performed.

Microscopic Colitis Symptoms

In general, microscopic colitis manifests the following symptoms:

  • Chronic diarrhea which is described to be watery and is frequently reported as non-bloody. The episodes of diarrhea is said to last for weeks, months or even worse, for years.
  • Abdominal discomfort and cramps
  • Abdominal bloating is noted
  • Rectal bleeding is not always present and is unusual
  • Anorexia may develop. Others would only experience mild weight loss.
  • Dehydration may occur if condition is not managed accordingly
  • Weakness, as electrolyte imbalance can result from persistent diarrhea
  • Some would experience problems with their bowel movement like fecal incontinence

Microscopic Colitis

Picture : Microscopic Colitis (lymphocytic colitis and the collagenous colitis)

Image source : hopkins-gi.org

Causes for Microscopic Colitis

Microscopic colitis is basically idiopathic in cause (unknown). However, research has provided data that can be associated to such digestive problem. Studies have presented that the immune system plays a great role in the development of microscopic colitis. An abnormal immune response is considered a vital part in the microscopic inflammation of the colon. The normal function of the immune system is to protect us from any harmful agents.

In microscopic colitis, it’s believed that our own immune response has attacked the normal bacteria of the body, particularly those in the colon. Because of this, microscopic inflammation occurs thus resulting to colitis. Research has somehow supported this as episodes of colitis symptoms are not present when the bowel is completely cleaned out.

In addition to causes, there are significant factors associated to the development of microscopic colitis. People develop microscopic colitis because of the following:

  1. Ingestion of harmful bacteria. There are certain bacterial infections believed to cause microscopic colitis. Yersinia enterocolitica, Campylobacter jejuni and Clostridium difficile bacteria have been reported, even after proper treatment and remission has been attained, to cause microscopic colitis.
  2. Medications. Study shows that chronic use of NSAIDs (nonsteroidal anti-inflammatory drugs) cause the disease. Other drugs to cause microscopic colitis are acarbose, aspirin, lansoprazole, ranitidine, and sertraline.


Experts say that the two types of microscopic colitis are a representation of the stages of the disease. The thing that sets the two apart is its slight differences in affectation. However, their presentation of the symptoms is the same. The two types of microscopic colitis are the following:

Collagenous colitis

When tissue sample from the colon is observed with collagenous colitis, presence of a scar tissue is observed. Basically, this thickening of the connective tissue causes the problem.

Lymphocytic colitis

It is called lymphocytic colitis because a collected tissue sample from the colon will show accumulation of white blood cells or what is medically known as lymphocytes.

Treatment for Microscopic Colitis

The treatment plan for microscopic colitis includes medication, surgery, and diet modification. But in order to attain good results, a great lifestyle change should be observed by the patient. Taking of certain medications, which are known to trigger the disease, should be stopped.

Medications recommended for microscopic colitis are the following:

  • Anti-diarrheal drugs. First line drug would be loperamide which is most effective in mild diarrhea. Bismuth subsalicylate will be prescribed when symptoms persist but are not that alarming.
  • When there are no responses after administration of the two drugs, prednisone and budesonide are provided. These are steroid medications that act to block inflammation or the inflammatory process. This two has been found quite effective in the process of treating microscopic colitis.
  • Provide supplements. As malabsorption may result from the chronic diarrhea, food supplements should be provided accordingly. Probiotics are considered helpful in the recovery period as this can help maintain a healthy digestive tract.

Surgical intervention is only necessary when the patient’s condition has become severe and there is persistence of symptoms, even after treatment is provided. This would involve the removal of a portion or the whole colon itself, depending on the case and severity of the condition. Resolution to surgery is rare in most cases.

Please note too that treatment should be done by a specialist only. Don’t do any self medication to avoid complications.

Diet for Microscopic Colitis

Proper diet is essential in microscopic colitis. In order to prevent episodes of diarrhea, the patient should follow this recommended diet:

  1. Grain-, lactose- and sucrose-free diet. This is the known specific carbohydrate diet. This plan would help in providing further damage unto the intestinal walls. It is known that bacteria feed off sugar, making this diet essential in remission from microscopic colitis.
  2. Low –fat and -fiber diet. Eating less fat can reduce overwork of the digestive tract. Since fat is hard to digest, irritation would only be worsened especially if one is suffering from microscopic colitis. It is advised that easy-to-digest foods are to be given to patients. Low fiber diet is recommended in order to attain normal bowel movements. Less diarrheal episodes will be noted with this diet plan.
  3. Taking of NSAIDs is restricted. As already mentioned, this over-the-counter drug can trigger or cause microscopic colitis, especially when taken in a long period of time.
  4. Drink plenty of water. Proper fluid replacement can somehow help in avoiding untoward results from chronic diarrhea. It is also suggested that electrolytes are added in the fluids (sodium and potassium). Drinks that contain electrolytes should be taken, especially after an episode of diarrhea.
  5. Frequent small feedings. This is much suggested to provide proper nutrition in most of the day.
  6. Avoid irritating foods. These would include spicy foods. Irritating food can only worsen the presenting symptoms of microscopic colitis.







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