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What Causes Microscopic Colitis To Flare-Up?

The microscopic colitis is the inflammation of colon and can be due to a variety of reasons. Whenever any of the reason exists in severe form, there is flare-up in microscopic colitis, resulting in severity of disease. Microscopic colitis is caused due to the inflammation and deposition of collagen in the inner layer of colon. The substances that irritate the colon should be strictly avoided.

What Causes Microscopic Colitis To Flare-Up?

What Causes Microscopic Colitis To Flare-Up?

Microscopic colitis is the condition characterized with inflammation in the colon. The symptoms include non-bloody diarrhea, fatigue, weight loss and abdominal pain. Thus, the factors which provide discomfort to the GI system worsen the condition. Care should be taken to avoid such factors as these may result in the situation which is hard to manage. Following are the causes due to which microscopic colitis may flare-up.

Certain Drugs: There are certain drugs which when used increase the inflammation of the GI tract and aggravate or flare-up the symptoms. These drugs may result in severe diarrhea and abdominal pain. The drugs under this category include antidepressants, Non-steroidal anti-inflammatory drugs, and Proton Pump Inhibitors. The microscopic colitis patient is advised to avoid these drugs and any drugs taken should be according to the advice of the physician and self-medication should not be done.

Hormonal Changes: Hormonal changes have a direct impact on the synthesis of the inflammatory mediators. The increase in inflammatory mediators may increase the inflammation and flare-up the microscopic colitis.

Irritant Diets: The patients of the microscopic colitis should undergo a balanced diet and the diet which is comfortable in digesting. A pre-digested diet is preferred so that it does not impact the already stressed gastrointestinal system. A diet rich in low fiber and low fat is preferred. If the diet is rich in fiber and fat, it may increase the chances of diarrhea. Further, the food which is easily absorbed by the intestine should be preferred. Any spicy food should be avoided as this may flare-up the microscopic colitis.

Heavy Meal: A single heavy meal put the pressure on the gastrointestinal system for digestion. The system is already functioning below its capacity and the stress on the system lead to flare-up the disease. It is advisable to eat light meals at frequent intervals rather than eating a heavy meal.

Lifestyle Factors: Various lifestyle factors also flare-up the microscopic colitis. The drinks such as coffee and carbonated water are harmful in these conditions. Further, beer and other alcoholic drink should be avoided. Patient should also refrain from smoking.

Autoimmune Disease: Microscopic colitis is said to be an autoimmune disorder. So, the occurrence of any other autoimmune disease such as rheumatoid arthritis and Systemic Lupus Erythematosus may lead to the aggravation of the microscopic colitis.

Infection: Any simultaneous infection, especially of the GI tract makes the situation more complex and the symptoms of the colitis are hard to manage.

Treatment for Microscopic Colitis

The treatment is both curative and symptomatic. The treatment strategy is made in such a way that the disease is treated, and the symptoms also subsides. Following are the treatments for microscopic colitis:

Antidiarrheal Medications: These drugs are used to control diarrhea which is the primary symptom of this disease. The drugs used are loperamide or diphenoxylate. Bismuth subsalicylate is also effective.

Mesalamine: It can be used to treat the symptoms, but studies suggest that it is less effective as compared to other alternatives.

Corticosteroids: Budesonide is used to reduce the inflammation and to manage the severe symptoms of microscopic colitis.

Immunomodifiers: Immunomodifiers, that modifies the immune system, are used for the treatment. Drugs include azathioprine or methotrexate.


The factors which flare-up the microscopic colitis may include drugs, hormonal changes, irritant diets, drinks containing caffeine and carbonated water, autoimmune disease and infection. The patient should avoid these factors so that the situation does not go out of hand which then requires complex and aggressive treatment strategy.


  1. Medscape. (2021). Collagenous and Lymphocytic Colitis Treatment & Management. https://emedicine.medscape.com/article/184704-treatment

Also Read:

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 31, 2023

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