What is microscopic colitis?

Written by: Dr Aathavan Loganayagam
Edited by: Laura Burgess

Microscopic colitis is a chronic condition that causes inflammation of the large bowel or colon, which leads to symptoms of watery diarrhoea and stomach cramps. The condition can be very painful but once it’s correctly diagnosed, the good news is that it can be treated and the quality of life is hugely improved.

Fortunately, one of our top gastroenterologists Dr Aathavan Loganayagam is here to explain everything you need to know about microscopic colitis; from the causes to the treatment options.

Woman lying on bed with stomach ache

What is microscopic colitis?

Microscopic colitis actually encompasses two conditions; collagenous and lymphocytic colitis.

These conditions are referred to as “microscopic” because, unlike other inflammatory bowel diseases such as Crohn’s disease and Ulcerative colitis, there is no sign of inflammation of the lining of the intestine when viewed during a colonoscopy procedure.

Microscopic colitis can only be diagnosed by biopsies of the colon, which demonstrate inflammation on the microscope.

What is the cause of microscopic colitis?

There are a number of theories regarding the cause of microscopic colitis although the precise cause is unknown. It is thought that a number of medications may be associated with microscopic colitis and cessation of these drugs may lead to an improvement in symptoms. Although the symptoms of collagenous colitis and lymphocytic colitis are similar, it is also unclear whether the two conditions are related.

What are the symptoms microscopic colitis?

Microscopic colitis typically causes chronic watery diarrhoea. These symptoms may either occur on an intermittent (more common) or continuous basis. Other associated symptoms may include abdominal discomfort, weight loss and lethargy. It does not cause bloody diarrhoea or rectal bleeding.

Who gets microscopic colitis?

Microscopic colitis is a relatively uncommon condition and is generally diagnosed in middle-aged and elderly individuals. Collagenous colitis is more common in females (female to male ratio 15:1). Lymphocytic colitis has no gender preponderance.

How is microscopic colitis diagnosed?

Microscopic colitis diagnosed on the basis of a normal colonoscopy with biopsies of the colon demonstrating characteristic “collagen” changes or an increased number of “lymphocytes” in the lining of the intestine.

Collagen is a protein which is part of scar tissue, whereas lymphocytes are a specific type of white blood cell in the immune system. The inflammatory changes seen in microscopic colitis may only be patchy and not affect the entire colon, and so multiple biopsies from different parts of the colon are recommended.

How is microscopic colitis treated?

The treatment for microscopic colitis depends on the severity of the symptoms and can include anti-diarrhoeal (e.g. loperamide) and steroids (e.g. budesonide). Some people are able to cease their medication without a recurrence in their symptoms, although relapse requiring repeated medical therapy may also occur.

Can microscopic colitis cause cancer?

There is no reported evidence of a link between microscopic colitis and cancer.

If you are concerned that you have symptoms of microscopic colitis, book an appointment with Dr Loganayagam now.

By Dr Aathavan Loganayagam

Dr Aathavan Loganayagam trained in medicine at Guy’s, King's and St. Thomas’ medical schools. He then underwent rigorous structured specialty training in gastroenterology and general internal medicine in the well respected South London training programme.

He then spent two years during postgraduate training as a research and endoscopy fellow at Guy’s and St Thomas’ Hospitals, London. His research was in the fields of pharmacogenetics, inflammatory bowel disease and gastrointestinal malignancy. He has received awards and grants for outstanding research work, including the prestigious NHS Innovation London Award.

Dr Loganayagam has numerous publications in peer reviewed journals on all aspects of gastroenterology. He is actively involved in clinical research. He has particular local expertise in the practice of personalised medicine and the utilisation of novel therapeutic agents in the treatment of complex inflammatory bowel disease. He is currently the lead clinician for endoscopy at Queen Elizabeth Hospital, Woolwich.

Diagnostic and advanced therapeutic endoscopy remains a major part of his clinical expertise, including assessment and treatment of inflammatory bowel disease, strictures, polyps and cancers.

Dr Loganayagam is an approachable doctor who takes pride in his communication skills with patients. He is keen to ensure that patients are fully informed and involved in all aspects of their care.

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