Microscopic Colitis

Microscopic Colitis is a relatively new type of colitis, recognized since the 1980’s as a form of microscopic inflammation, which causes chronic diarrhea.  All stool studies, labs and x-rays are usually normal.  Even the Colonoscopy appears normal, and only if biopsies are taken and examined under the microscope can the diagnosis be made.

There are 2 types that we find: (1) Lymphatic colitis (equal in men and women) and (2) collagenous colitis (5:1, female: male ratio).  Sometimes a single individual has both types.

Patients usually have non-bloody diarrhea with stools ranging from less than or equal to 3/day (33%), to 4-9/day (52%) and more than 10/day (15%).  In our study 47% of cases began suddenly and 53% insidiously.  66% of patients had only one episode of colitis, whereas 34% had either recurrent bouts or chronic symptoms.  This is in contrast to other studies that showed few single episodes, and mostly chronic intermittent problems.  10% of our patients had concomitant celiac disease.

Treatments can include antibiotics such as Azulfidine & Flagyl, Lomotil/Immodium, and steroids, which were the most effective (Prednisone, Entocort).

As opposed to other studies we found only about 22% had abdominal pain or weight loss.

In summary, microscopic colitis is primarily a disease of middle aged women, can begin suddenly or insidiously, with the majority improving within 2 months.  Some will have chronic or recurrent diarrhea and require ongoing therapy, the most successful being low dose Prednisone.  The overall number of cases is still small and it appears to still lag far behind the frequency of ulcerative colitis. 

In our study, we had a total of 39 patients with microscopic colitis over the past 10 years.  78% female and 22% male.  There were equal numbers of males and females with lymphocytic colitis, but 5 times as many females had collagenous colitis.

The clinical presentations were sudden onset of diarrhea in 47% and insidious diarrhea in 53%.  66% were cured with their first episode, but 34% had either recurrent bouts or chronic continuous symptoms.

Prednisone was the treatment of choice, effective in almost every case.

Of note, almost 10% of our patients had celiac disease.

The complete abstract will be made available once it is published.