Microscopic colitis
From Ganfyd
A condition characterised by chronic, non-bloody, watery diarrhoea in patients with macroscopically normal or near-normal colonoscopic appearances, but where biopsy reveals two, sometimes overlapping, patterns of inflammation: lymphocytic colitis or collagenous colitis.
Other features include fatigue, nausea, abdominal pain, weight loss and difficult controlling continence. See review in [1][2]
Collagenous colitis was first described in 1976[3] and lymphocytic colitis somewhat later in 1989.[4] It is regarded as uncommon disorder, with one series showing an incidence of 0.9 and 0.4 for lymphocytic and collagenous colitis respectively.[5] True incidence may be underestimated due to under-recognition and failure to biopsy. The same study found that 10.2% of patients with chronic, watery diarrhoea had microscopic colitis. An American study shows an increase in incidence, possibly due to increased recognition.[6]
Retrospective reviews of patients with the clinical features of microscopic colitis show a reasonable prevalence of the disease. In a small Dutch series, 13 out of 103 patients with chronic diarrhoea showed features consistent with microscopic colitis.[7] Of note, 23% had disease confined to the right side of the bowel. In a Turkish series, 15 out of 129 patients with previously normal colonoscopic appearences, but with unexplained diarrhoea had microscopic colitis on biopsy.[8]
Aetiology is unclear, but there may be an autoimmune element.
Mainstay of treatment is steroids, though good quality evidence is lacking.[9][10] Treatment with bismuth-based compounds and 5-aminosalicylates is also described.
Contents |
Histological Features
Lymphocytic colitis
- Mixed inflammatory infiltrate in the lamina propria
- Intra-epithelial lymphocytes (>5-10 lymphocytes per 100 epithelial cells - no agree figure)
- Preserved crypt architecture
Collagenous colitis
- Thickened subepithelial collagenous band (some sources suggest >10 microns)
This article is a stub. Please feel free to expand it and make it more encyclopaedic.
References
- ↑ Nyhlin N, Bohr J, Eriksson S, Tysk C. Systematic review: microscopic colitis. Alimentary pharmacology & therapeutics. 2006 Jun 1; 23(11):1525-34.(Link to article – subscription may be required.)
- ↑ Nyhlin N, Bohr J, Eriksson S, Tysk C. Microscopic colitis: a common and an easily overlooked cause of chronic diarrhoea. European journal of internal medicine. 2008 May; 19(3):181-6.(Link to article – subscription may be required.)
- ↑ Lindström CG. 'Collagenous colitis' with watery diarrhoea--a new entity? Pathologia Europaea. 1976; 11(1):87-9.
- ↑ Lazenby AJ, Yardley JH, Giardiello FM, Jessurun J, Bayless TM. Lymphocytic ("microscopic") colitis: a comparative histopathologic study with particular reference to collagenous colitis. Human pathology. 1989 Jan; 20(1):18-28.
- ↑ Jaskiewicz K, Rzepko R, Adrych K, Smoczyński M. Microscopic colitis in routine colonoscopies. Digestive diseases and sciences. 2006 Feb; 51(2):241-4.(Link to article – subscription may be required.)
- ↑ Pardi DS, Loftus EV, Smyrk TC, Kammer PP, Tremaine WJ, Schleck CD, Harmsen WS, Zinsmeister AR, Melton LJ, Sandborn WJ. The epidemiology of microscopic colitis: a population based study in Olmsted County, Minnesota. Gut. 2007 Apr; 56(4):504-8.(Link to article – subscription may be required.)
- ↑ Thijs WJ, van Baarlen J, Kleibeuker JH, Kolkman JJ. Microscopic colitis: prevalence and distribution throughout the colon in patients with chronic diarrhoea. The Netherlands journal of medicine. 2005 Apr; 63(4):137-40.
- ↑ Erdem L, Yildirim S, Akbayir N, Yilmaz B, Yenice N, Gultekin OS, Peker O. Prevalence of microscopic colitis in patients with diarrhea of unknown etiology in Turkey. World journal of gastroenterology : WJG. 2008 Jul 21; 14(27):4319-23.
- ↑ Chande N, McDonald JW, Macdonald JK. Interventions for treating collagenous colitis. Cochrane database of systematic reviews (Online). 2008; (2):CD003575.(Epub) (Link to article – subscription may be required.)
- ↑ Chande N, McDonald JW, Macdonald JK. Interventions for treating lymphocytic colitis. Cochrane database of systematic reviews (Online). 2008; (2):CD006096.(Epub) (Link to article – subscription may be required.)
