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Microscopic Colitis

Chronic inflammatory bowel disease with chronic watery diarrhea that appears normal on endoscopy.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Dahiliye (İç Hastalıkları) department. Book Appointment →

What is Microscopic Colitis?

Microscopic colitis is an inflammatory bowel disease that presents with chronic non-bloody watery diarrhea, appearing macroscopically normal on colonoscopy but giving characteristic findings on histopathology. It has two main types: lymphocytic colitis and collagenous colitis.

In lymphocytic colitis, increased epithelial lymphocyte count (>20/100 epithelial cells) and in collagenous colitis, thickening of the subepithelial collagen band (>10 μm) make the diagnosis. The disease is especially seen in women over age 60 and is an important cause of chronic diarrhea in middle-aged women.

In pathogenesis, exposure to drugs such as NSAIDs, PPIs, SSRIs, autoimmune diseases (celiac, thyroiditis), smoking, and bile acid malabsorption play roles. Budesonide is the gold standard in treatment, and remission is achieved in most cases.

Symptoms

Chronic watery, non-bloody diarrhea
Diarrhea waking from sleep
Abdominal pain and cramps
Fecal incontinence
Sudden urge to defecate
Weight loss
Fatigue and weakness
Dehydration and electrolyte disturbances

Risk Factors

Female gender and being over age 60
Autoimmune diseases (celiac, thyroiditis, RA)
Smoking
Use of NSAIDs and aspirin
Proton pump inhibitors
SSRI antidepressants
Bile acid malabsorption
Genetic predisposition

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Chronic watery diarrhea (>4 weeks)
  • Diarrhea waking from sleep
  • Unexplained weight loss
  • Persistent diarrhea despite normal colonoscopy
  • Signs of dehydration
  • Coexisting autoimmune disease history

Treatment Methods

01
Budesonide 9 mg/day for 8 weeks (first choice)
02
Discontinuation of triggering drugs (NSAIDs, PPI, SSRI)
03
Loperamide symptomatic in mild cases
04
Bismuth subsalicylate as alternative
05
Cholestyramine if bile acid malabsorption present
06
Immunosuppressants (azathioprine) in resistant cases
07
Smoking cessation
08
Celiac disease screening

Which Department to Visit?

You can visit our Dahiliye (İç Hastalıkları) department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Dahiliye (İç Hastalıkları) Department

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.