Microscopic colitis is a type of inflammation of the colon or large intestine that causes persistent watery diarrhea and abdominal cramps. It is a type of inflammatory bowel disease. It is called microscopic because the inflammation can only be seen under a microscope as it’s too small to be seen with the naked eye. There are two types of microscopic colitis, lymphocytic and collagenous colitis. In patients with lymphocytic colitis, there is an increase in lymphocytes or white blood cells in the epithelium (the lining of the colon) while in collagenous colitis the layer of collagen (fibrous connective tissue) under the epithelium becomes thicker.
Does Microscopic Colitis Cause Joint Pain?
Since the primary symptoms of microscopic colitis include chronic watery diarrhea, it rarely leads to joints pain. However, other autoimmune conditions such as ulcerative colitis and Crohn’s disease can lead to joint pain and stiffness. But the cases of joint pain associated with microscopic colitis have not been found.
Causes And Symptoms Of Microscopic Colitis
Microscopic colitis usually affects older people above the age group of 50 years, who have certain autoimmune diseases such as celiac disease, thyroid diseases, rheumatoid arthritis and psoriasis. Certain medications such as non-steroidal anti-inflammatory drugs such as aspirin, ibuprofen and naproxen, antacid and heartburn drugs, antidepressants and drugs for treatment of cancer or heart disease might all lead to microscopic colitis. Infections caused by bacteria and viruses cause inflammation of colon. Genetics also plays a role in transmission of microscopic colitis. Certain habits such as of tobacco use might lead to colitis.
Symptoms of microscopic colitis include:
The main symptom is non-bloody diarrhea that may persist for some time. There is always a feeling of having bowel movements. Other symptoms are weight loss, pain and abdominal cramps, fecal incontinence (leaky stools, caused due to inability to control bowel movements), nausea, dehydration and bile acid malabsorption that cause watery stools. Edema and inflammation of the colon’s lining interferes with the absorption of water from the undigested food, and the unabsorbed water exits from the rectum as diarrhea along with pus and fluid that add to the diarrhea. There is also rectal bleeding present sometimes, due to bleeding from the lining of the colon that has ulcerations on them.
Diagnosis Of Microscopic Colitis
A person usually presents with chief complaints of watery diarrhea associated with weight loss, abdominal pain and fatigue that has persisted for over 2 weeks. The diagnosis is confirmed with the help of multiple biopsies taken from different segments of colon from different regions. This helps with making an accurate diagnosis of microscopic colitis.
Due to the patchy distribution of microscopic colitis flexible sigmoidoscopy is inadequate in diagnosing this condition since abnormalities of the disease may be absent from sigmoid colon (the colonic segment that is closest to the rectum) in some patients of microscopic colitis. Thus biopsies of other regions of the colon may be done via colonoscopy to diagnose microscopic colitis.
What Is The Treatment For Microscopic Colitis?
Some cases of microscopic colitis resolve without any specific treatment. The other cases that require medical intervention may be given antidiarrheal agents such as loperamide (imodium), diphenoxylate and atropine (lomotil). The other drugs used are bismuth subsalicylate (pepto-Bismol), budenoside (Entocort EC), 5-ASA (mesalamine) compounds such as Asacol, Pentasa, or Colazal. For more severe cases of microscopic colitis antibiotics and anti-inflammatory drugs may be given. The anti-inflammatory drugs used are mesalamine, sulfasalazine and budenoside.
Controlled trials have shown budenoside to be effective in controlling diarrhea in more than 75% of the patients with collagenous colitis. The only disadvantage is that the diarrhea tends to recur soon after stopping budenoside. Corticosteroids such as prednisone may also be used to treat microscopic colitis.
In some cases, use of azathioprine and 6-mercaptopurine has been shown to suppress the immune system where other medications have failed to show response. However, the use of NSAIDs should be prevented that may lead to microscopic colitis. Lactose elimination can be tried in case where milk might aggravate the diarrhea.
- Mayo Clinic. (2021). Microscopic colitis. https://www.mayoclinic.org/diseases-conditions/microscopic-colitis/symptoms-causes/syc-20351421
- National Institute of Diabetes and Digestive and Kidney Diseases. (2017). Microscopic Colitis. https://www.niddk.nih.gov/health-information/digestive-diseases/microscopic-colitis
- Shah, A., & Talley, N. J. (2016). Microscopic colitis: Insights into pathophysiology, diagnosis, and treatment. Digestive Diseases and Sciences, 61(9), 2355-2362.
- Münch, A., Langner, C., & Miehlke, S. (2020). Management of Microscopic Colitis: Challenges and Solutions. Therapeutic Advances in Gastroenterology, 13, 1756284820971963.
- Bohr, J., Wickbom, A., Hegedus, A., Nyhlin, N., Hultgren Hörnquist, E., & Tysk, C. (2013). Diagnosis and management of microscopic colitis: current perspectives. Clinical and Experimental Gastroenterology, 6, 29–39.
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