Diagnosis and management of microscopic colitis

Abstract

Microscopic colitis, comprising collagenous and lymphocytic colitis, is characterized clinically by chronic watery diarrhea, and a macroscopically normal colonic mucosa where diagnostic histopathological features are seen on microscopic examination. The annual incidence of each disorder is 4-6/100 000 inhabitants, with a peak incidence in 60-70-year-old individuals and a noticeable female predominance for collagenous colitis. The etiology is unknown. Chronic diarrhea, abdominal pain, weight loss, fatigue and fecal incontinence are common symptoms, which impair the health-related quality of life of the patient. There is an association with other autoimmune disorders such as celiac disease, diabetes mellitus, thyroid disorders and arthritis. Budesonide is the best-documented shortterm treatment, but the optimal long-term strategy needs further study. The long-term prognosis is good and the risk of complications including colonic cancer is low.

Are collagenous and lymphocytic colitis different aspects of the same disease?

“…They share many features, such as the clinical symptoms, association to autoimmune diseases and response to treatment [2,3]. Although they share some histological features they can be separated by histopathology [1].…”

“…Other common symptoms include nocturnal diarrhoea, diffuse abdominal pain and weight loss [1]. Lymphocytic (LC) and collagenous (CC) colitis are two main subtypes of MC.…”

Is smoking a risk factor for collagenous colitis?

“…The condition was first described in Sweden in 1976 [1] and is characterized clinically by chronic watery diarrhoea and has a female predominance with a peak incidence in 60-year-old individuals. [2] Drugs, luminal factors and infections are factors discussed in the development of CC, but the aetiology is still unknown. [3][4][5].…”

Protein-losing Enteropathy Associated with Collagenous Colitis Cured by Withdrawal of a Proton Pump Inhibitor

“…Collagenous colitis involves a macroscopically normal or nearly normal colonic mucosa with distinctive histopathological features of chronic inflammation in the lamina propria, thickening of the subepithelial collagen layer and epithelial cell damage with or without an increase in the number of intraepithelial lymphocytes. The incidence of CC is highest among women approximately 65 years of age (4), and the condition is usually histopathologically diagnosed as an increase of >10 μm in the thickness of the subepithelial collagen layer. Protein-losing enteropathy (PLE) is a rare and occasionally life-threatening syndrome characterized by the massive enteric loss of plasma proteins, resulting in hypoproteinemia, which can cause general edema, ascites, pleural and pericardial effusions and malnutrition.…”