Microscopic colitis

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Microscopic colitis
Collagenous colitis - intermed mag.jpg
Micrograph of collagenous colitis, a type of microscopic colitis. H&E stain.
Classification and external resources
Specialty gastroenterology
ICD-10 K52.8
ICD-9-CM 558.9
DiseasesDB 30087
eMedicine med/1351
MeSH D046728

Microscopic colitis refers to two related medical conditions which cause diarrhea: collagenous colitis and lymphocytic colitis.[1][2] Both conditions are characterized by the presence of chronic watery diarrhea, normal appearances on colonoscopy and characteristic histopathology findings of inflammatory cells.

Clinical features[edit]

People who develop microscopic colitis are characteristically, though not exclusively, middle-aged females. The average age of diagnosis is 65 but 25% of cases are diagnosed below the age of 45.[1] Patients have a long history of watery diarrhoea, which may be profuse. Microscopic colitis is the diagnosis in around 10% of cases investigated for chronic non-bloody diarrhea.[1]

Colonoscopic appearances are normal or near normal. Multiple colonic biopsies are taken in order to make the diagnosis. As the changes are often patchy, an examination limited to the rectum may miss cases of microscopic colitis, and so a full colonoscopy has been recommended.[1]

Associated conditions[edit]

A higher incidence of autoimmune diseases, for example arthritis, Sjögren's syndrome, and coeliac disease, has been reported in patients with microscopic colitis. Associations with various drugs have been found, especially proton pump inhibitors, H2 blockers, and non-steroidal anti-inflammatory drugs (NSAIDs).[1] Bile acid diarrhea is found in 41% of patients with collagenous colitis and 29% with lymphocytic colitis.[2]


Microscopic colitis is characterized by an increase in inflammatory cells, particularly lymphocytes, in colonic biopsies with an otherwise normal appearance and architecture of the colon.[1] Inflammatory cells are increased both in the surface epithelium ("intraepithelial lymphocytes") and in the lamina propria. The key feature is more than 20 intra-epithelial lymphocytes per 100 epithelial cells.[1] In lymphocytic colitis, these are the principal abnormal features. In collagenous colitis, the features of lymphocytic colitis are present, with, in addition, the presence of a thickened subepithelial collagen layer which may be up to 30 micrometres thick. The two types of microscopic colitis share many other features including epidemiology, risk factors and response to therapy which has led to the suggestion they are two subtypes of the same disease.[2]


Lymphocytic and collagenous colitis have both been shown in randomized, placebo-controlled trials to respond well to budesonide.[3][4] Budesonide, in formulations designed to be active in the distal intestine, is effective for both active disease and in the prevention of relapse.[1]

Studies have been performed in both forms of microscopic colitis of treatment with a number of other agents including bismuth subsalicylate (Pepto-Bismol), mesalazine/mesalamine (with or without cholestyramine), systemic corticosteriods and probiotics.[5][6] The evidence for their effectiveness is less good than that for budesonide.[1]


The prognosis for lymphocytic colitis and collagenous colitis is good, and both conditions are considered to be benign.[7] The majority of people afflicted with the conditions recover from their diarrhea, and their histological abnormalities resolve,[4] although relapses can occur and maintenance treatment may be required.[1]

See also[edit]


  1. ^ a b c d e f g h i j Münch A, Aust D, Bohr J, Bonderup O, Fernández Bañares F, Hjortswang H, et al. (2012). "Microscopic colitis: Current status, present and future challenges: statements of the European Microscopic Colitis Group.". J Crohns Colitis 6 (9): 932–45. doi:10.1016/j.crohns.2012.05.014. PMID 22704658. 
  2. ^ a b c Rasmussen MA, Munck LK (2012). "Systematic review: are lymphocytic colitis and collagenous colitis two subtypes of the same disease - microscopic colitis?". Aliment Pharmacol Ther 36 (2): 79–90. doi:10.1111/j.1365-2036.2012.05166.x. PMID 22670660. 
  3. ^ Chande N, MacDonald JK, McDonald JW (2009). "Interventions for treating microscopic colitis: a Cochrane Inflammatory Bowel Disease and Functional Bowel Disorders Review Group systematic review of randomized trials.". Am J Gastroenterol 104 (1): 235–41; quiz 234, 242. doi:10.1038/ajg.2008.16. PMID 19098875. 
  4. ^ a b Fernández-Bañares F, Salas A, Esteve M, Espinós J, Forné M, Viver J (2003). "Collagenous and lymphocytic colitis. evaluation of clinical and histological features, response to treatment, and long-term follow-up.". Am J Gastroenterol 98 (2): 340–7. doi:10.1111/j.1572-0241.2003.07225.x. PMID 12591052. 
  5. ^ Chande N, McDonald JW, Macdonald JK (2008). "Interventions for treating lymphocytic colitis.". Cochrane Database Syst Rev (2): CD006096. doi:10.1002/14651858.CD006096.pub3. PMID 18425936. 
  6. ^ Chande N, McDonald JW, Macdonald JK (2008). "Interventions for treating collagenous colitis.". Cochrane Database Syst Rev (2): CD003575. doi:10.1002/14651858.CD003575.pub5. PMID 18425892. 
  7. ^ Mullhaupt B, Güller U, Anabitarte M, Güller R, Fried M (1998). "Lymphocytic colitis: clinical presentation and long term course". Gut 43 (5): 629–33. doi:10.1136/gut.43.5.629. PMC 1727313. PMID 9824342. 

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