As the name suggests, microscopic colitis is the inflammation of human colon that is only perceptible under a microscope. The colon, in a microscopic colitis, looks normal to a naked eye, so a biopsy needs to be performed in order to diagnose the condition. Inflammation is a general response of the body towards any irritation, infection or injury to the tissues. Microscopic colitis is a type of inflammatory bowel disease (a general name for the diseases that cause irritation & inflammation in the intestines).
Can Microscopic Colitis Cause Nausea?
The chances of microscopic colitis are greater in older individuals (people over the age of 50 years), females, individuals with established autoimmune conditions, cigarette smokers & individuals on medicines linked to the disease.
The most common symptom of microscopic colitis is chronic, watery, non-bloody diarrhea that can last for weeks, months to years & individuals with microscopic colitis can even have long periods without any signs of diarrhea. Although, diarrhea is the most common symptom of microscopic colitis, they can even have symptom of nausea. Other symptoms related to microscopic colitis include fecal incontinence, strong urgency to defecate, pain, cramping or abdominal bloating, dehydration & weight loss.
The symptoms of microscopic colitis are intermittent & on occasions, the symptoms even resolve without the need of any treatment.
Types Of Microscopic Colitis
Microscopic colitis can be divided into two types – lymphocytic colitis & collagenous colitis. The symptoms & treatment for both the types are the same & some researchers are of the belief that both the types are different phases of the same condition, i.e. microscopic colitis. In both the types of colitis, there is an increase in the number of lymphocytes (a type of white blood cells); however, in collagenous colitis, the collagen layer under the epithelium becomes thicker than normal; the collagen layer is normal in lymphocytic colitis.
Causes Of Microscopic Colitis
The etiology of microscopic colitis remains idiopathic. Several factors have been postulated as a probable cause of microscopic colitis; however, most probable cause seems to be abnormal immune system response to the gut bacteria. Other probable causes include infections, autoimmune conditions, medicines, genetic factors & bile acid malabsorption.
Bacterial as well as viral infections have been postulated to play a major role in microscopic colitis.
No medication is found to cause microscopic colitis; however, there is a link between certain medicines & microscopic colitis. These medicines include NSAIDs (aspirin, ibuprofen, naproxen), lansoprazole, acarbose, ranitidine, sertraline, carbamazepine, clozapine, esomeprazole, lisinopril, omeprazole, pantoprazole, rabeprazole & simvastatin.
Several genes have been linked to other types of inflammatory bowel diseases (Crohn’s disease, ulcerative colitis).
Diagnosis Of Microscopic Colitis
The diagnosis of microscopic colitis starts with a complete medical & family history along with a physical exam. Lab tests (blood test & stool test), imaging tests of the intestines (CT scan, MRI, upper GI) & endoscopy of the intestines (colonoscopy, flexible sigmoidoscopy & upper GI endoscopy) may be performed to rule out other bowel diseases, such as irritable bowel disease, celiac disease, Crohn’s disease, ulcerative colitis & infectious colitis that have the same symptoms similar to those of microscopic colitis. The confirmatory diagnosis is done by biopsy carried out at the time of endoscopy, which will either show lymphocytic colitis, collagenous colitis or a combination of the two.
Treatment of Microscopic Colitis
The treatment of microscopic colitis depends on the severity of the condition. It is treated by a gastroenterologist who will review the medicines taken by the patient & if required may adjust the medicines & advice lifestyle modifications with diet & nutrition. The most common medicines prescribed for microscopic colitis are antidiarrheal (Pepto-Bismol, Lomotil, loperamide), corticosteroids (budesonide, prednisone), anti-inflammatories (mesalamine, sulfasalazine), cholestyramine resin (Locholest, Questran) for blocking bile acids, antibiotics (metronidazole, erythromycin), immunomodulators (mercaptopurine, methotrexate, azathioprine) & anti-TNF (infliximab, adalimumab). When medicines are not effective, surgery is the last resort; however, it is quite rare.
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