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Microscopic Colitis: Causes, Symptoms, Diagnosis, Treatment, Diet

What Is Microscopic Colitis?

Microscopic Colitis is a pathological condition of the digestive system, specifically the large intestine, in which there is inflammation of large intestine causing persistent watery diarrhea. This condition gets its name due to the fact that it can be identified only when the affected tissues of the large intestine are examined under a microscope. Microscopic Colitis is hypothetically classified into two following types:

Collagenous Colitis: In this type, when the tissue is examined under the microscope there can be a thick layer of collagen observed along with the inflammation.

Microscopic Colitis

Lymphocytic Colitis: In this type, when the tissues from the large intestine are examined under the microscope, abundant lymphocytes are observed in the tissues

It is still a matter of ongoing research whether the above mentioned two types of Microscopic Colitis are separate entities or stages of the same disease process since their symptoms are more or less pretty similar as are the ways to diagnose them and the treatments rendered to cure them. The symptoms of Microscopic Colitis wax and wane pretty rapidly and at times they go away on their own. At other times medications are required for relief of symptoms.

What Are The Causes Of Microscopic Colitis?

It is not clearly known as of now as to what causes Microscopic Colitis. It is estimated that there may be several causes which can result in development of this disease; however, most commonly it is caused due to an uncharacteristic response by the immune system of the body towards bacteria that usually reside in the colon. Researchers have also come up with certain medical conditions like autoimmune diseases or certain infections and certain medications can also cause Microscopic Colitis. They have also suggested a genetic predisposition to this disease, although it has not been definitively proven as of now. Microscopic Colitis can also be caused due to inadequate ability by the body to absorb bile acids.

Autoimmune Diseases: Some autoimmune disorders that can cause Microscopic Colitis are:

  • Celiac disease, which is a medical condition in which individuals become intolerant of a substance called gluten present in the food.
  • Thyroid disorders like Hashimoto’s thyroiditis or hyperthyroidism
  • Rheumatoid Arthritis, which is a condition which causes severe pain in the joints of the body.

Medications: Microscopic Colitis is also known to be caused by medications. Certain medications which researchers have identified as drugs, which can possibly cause Microscopic Colitis are:

  • NSAIDs like aspirin and ibuprofen
  • Prevacid
  • Precose
  • Zantac
  • Zoloft
  • Ticlid
  • Carbamazepine
  • Comtan
  • Nexium
  • Zestril
  • Prilosec
  • Protonix
  • Paxil
  • Aciphex
  • Zocor.

Infections: Microscopic Colitis can also be caused as a result of harmful bacteria or viruses causing infection in the GI tract and affecting the digestive system adversely and result in development of Microscopic Colitis.

Genetic Predisposition: Some researchers are of the opinion that there is a genetic predisposition to the development of Microscopic Colitis, although they have not been able to pinpoint any one specific gene linked to Microscopic Colitis.

Inadequate Absorption of Bile Acids: Researchers are also of the opinion that Microscopic Colitis may develop due to inability of the body to appropriately absorb bile acids which help in breakdown of fats in the food.

What Are The Symptoms Of Microscopic Colitis?

Some of the symptoms of Microscopic Colitis are:

  • Persistent watery diarrhea
  • Cramping pain in the abdomen
  • Weight loss
  • Nausea
  • Bowel incontinence.

How Is Microscopic Colitis Diagnosed?

In order to diagnose Microscopic Colitis, the treating physician will conduct a detailed history and physical examination in order to identify any prior condition which may irritate or inflame the colon to include celiac disease or rheumatoid arthritis. The physician will also inquire about intake of certain medications which may irritate the colon like aspirin or ibuprofen.

Other tests that are done to diagnose Microscopic Colitis are:

  • Stool analysis in order to rule out other disorders causing diarrhea
  • Tests to rule out celiac disease like upper endoscopy and biopsy
  • Procedures like colonoscopy or flexible sigmoidoscopy to rule out other intestinal conditions.

What Are The Treatments For Microscopic Colitis?

Majority of times, symptoms caused due to Microscopic Colitis go away on their own and do not require any treatment; however, if the symptoms become severe and are more persistent then treatment may be required. Treatment for such symptoms is done in a staged fashion. These stages are as follows:

  • Dietary Changes To Treat Microscopic Colitis: To begin with, the physician will suggest a change in the diet or medications that the affected individual may be taking. The physician will suggest taking a low-fat, low-fiber diet which usually relieves diarrhea. The physician will ask to discontinue all medications that may potentially be causing irritation of the colon.
  • Medications To Treat Microscopic Colitis: The treating physician may prescribe the following medications: Anti-diarrheal drugs, medications which aid in blockage of bile acids which is major contributor to diarrhea, antiinflammatory medications to control inflammation, immune suppressing medications to calm down the inflammation.
  • Surgery For Microscopic Colitis: This is done when the symptoms of Microscopic Colitis become extremely severe and are not controlled by medications or other conservative measures described above. It is then that the physician will recommend surgery for removal of partial or the entire colon but this treatment is extremely rare and is usually not required.

Microscopic Colitis: Comprehensive Diet Plan

Significant symptom relief can be obtained if a proper diet plan for Microscopic Colitis is followed as explained in detail below:

  • Specific Carbohydrate Diet For Microscopic Colitis: This form of diet is commonly used in cases of Microscopic Colitis for alleviation of symptoms. This diet consists of foods which are free of substances like grains, lactose, and sucrose. This diet is formulated on the grounds that harmful bacteria and yeast are the primary microbes involved in development of most of the intestinal infections due to presence of carbohydrates. These offending microbes blossom on sugar present in carbohydrates and cause harm to the cells in the intestinal wall. This form of diet reduces the amount of carbohydrates and also helps with digestion.
  • Gluten Free Diet Recommended For Microscopic Colitis: it is opined in various studies conducted that Microscopic Colitis is usually found in people who have a medical condition called Celiac Disease which is a disease in which an individual is allergic to gluten. Hence it has been recommended in the studies that a gluten free diet be followed and it has shown positive results for many individuals who have Microscopic Colitis. Some of the examples of gluten free foods are unprocessed beans or nuts, fresh eggs, fish, corn, millet etc.
  • Supplements: it is well known that Microscopic Colitis causes extensive diarrhea in people. Due to chronic diarrhea, a lot of electrolytes and fluids are lost from the body which may result in lack of proper nutrition which the body needs to function adequately. Hence it is suggested that multivitamins and supplements be used to replenish the lost nutrients from the body. Probiotic, also known as the good bacteria goes a long way in resurrecting the digestive system and keeping it healthy. Probiotic has shown the positive results in people who have Microscopic Colitis. It also produces compounds, which eliminates the harmful bacteria from the digestive system.


  1. “Microscopic Colitis” by National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Link: https://www.niddk.nih.gov/health-information/digestive-diseases/microscopic-colitis

  2. “Microscopic Colitis” by Cleveland Clinic Link: https://my.clevelandclinic.org/health/diseases/17938-microscopic-colitis

Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:August 23, 2023

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