Microscopic Colitis - An Overview

Introduction:

The hallmark of microscopic colitis, a long-term inflammatory colon illness, is persistent, watery, non-bloody diarrhea. It usually affects individuals who are in their middle years and is more common in women. When individuals with microscopic colitis undergo a colonoscopy, their colon usually looks normal or nearly normal. The diagnosis is established through a biopsy of the intestinal mucosa that exhibits distinctive histologic alterations. The two primary histologic subtypes of microscopic colitis, initially identified in 1980, are collagenous colitis and lymphocytic colitis, further defined in 1989.

What Is Microscopic Colitis?

One of the lesser-known forms of inflammatory bowel disease (IBD) (a collection of inflammatory diseases that affect the small intestine and colon) is microscopic colitis (MC). These are long-term intestinal (intestine) inflammatory disorders. "Colitis" refers to inflammation of the colon (the large intestines). Because it can only be seen under a microscope, it is referred to as "microscopic."

The intestinal lining's cells become inflamed in people with microscopic colitis. The most typical outcome is regular, runny diarrhea. Microscopic colitis is a chronic illness that can come and go like any other. It could become more intense in response to specific stimuli, then naturally fade, only to reappear. Despite being a chronic illness, it is typically treatable with medication.

What Is the Pathology Behind Microscopic Colitis?

It is unknown and quite likely that there are multiple biological mechanisms behind the development of microscopic colitis. Clinical manifestations of various consequences may also result from histological abnormalities in microscopic colitis. As an immune-mediated illness, microscopic colitis is characterized by a crucial role in the adaptive immune system and cytotoxic responses. In genetically predisposed people, uncontrollable immune responses to different luminal and mucosal effects may transpire.

The mucosa is impacted by bacteria and exogenous toxins from the intestinal lumen, which can also set off immune reactions. Increased intestinal permeability and decreased tight-junction protein expression make this possible. TNF-α and other interleukins are overexpressed due to a variable cytokine profile. A decrease in the concentration of Akkermansia species in certain cases has led to an increased interest in the involvement of gut microbiota in MC development. This might be a secondary effect rather than a fundamental pathogenetic element.

Who Does Microscopic Colitis Affect?

Although it can affect anyone, elderly individuals and those who were born with a feminine gender assignment are more likely to have it. Additionally, individuals who smoke and those with specific autoimmune diseases, particularly celiac disease, are more likely to experience it. It has long been believed that other inflammatory bowel disorders are more common than microscopic colitis.

What Causes Microscopic Colitis?

Various factors could be at play, such as:

• Exposure to viruses, bacterial toxins, and specific microorganisms.

• An autoimmune response is a mistake made by the immune system.

• Genetics.

According to several studies, the following drugs may be part of the issue:

• Beta-blockers.

• Statins.

• NSAIDs or nonsteroidal anti-inflammatory medications.

• Proton pump inhibitors (PPIs).

• SSRIs, or selective serotonin reuptake inhibitors.

• Hormone replacement therapy (HRT).

What Are the Symptoms of Microscopic Colitis?

The hallmark sign of microscopic colitis is persistent diarrhea. Though some people may experience diarrhea more or less frequently, the average person experiences diarrhea five to ten times each day.

Commonly occurring secondary symptoms consist of:

• Tightness in the abdomen and discomfort.

• Distension and bloating of the abdomen.

• A strong need to poop and difficulty holding it in.

• Digestive system that is noisy.

• Gluten intolerance.

• Weariness.

Severe symptoms may consist of:

• Dehydration.

• Vomiting and queasy feeling.

• Reduced weight.

Some individuals additionally report:

• Painful or cramping muscles.

• Aches and stiffness in the joints.

• Migraines or headaches.

• Mouth ulcers.

• Skin irritations.

• Acid reflux disease.

• Lymph nodes are swollen.

• Thyroid issues.

How Is Microscopic Colitis Treated?

Smallpox colitis might resolve on its own. However, if a person's symptoms are severe or do not go away, they can require medical attention. Medical professionals typically start the easiest treatments with the lowest chance of adverse effects.

If the patient's symptoms persist, the medical practitioner might recommend:

• Medications that prevent diarrhea, such as Bismuth subsalicylate or Loperamide.

• Hormones like Budesonide.

• Bile acid-blocking medications, such as Colestipol or Cholestyramine/Aspartame.

• Medications like Mercaptopurine and Azathioprine suppress the immune system to lessen colon edema and discomfort.

• Biologic medications, like Vedolizumab, Adalimumab, and Infliximab. These can lessen intestinal inflammation and edema.

Dietary changes and quitting some medications include:

• Usually, the first line of treatment consists of dietary modifications and medications that can ease diarrhea.

The medical practitioner may advise one to:

• Consume a diet low in fat and fiber. Lower-fat and lower-fiber foods may provide temporary relief from diarrhea. However, this diet might not be helpful for microscopic colitis in the long run.

• Reduce the intake of sweets, coffee, dairy, and gluten. These foods might exacerbate the symptoms.

• Give up using any medications a person thinks may be causing the problems. One might need to switch to a different medication to treat an illness.

Surgery

Rarely, if medication is not helping and a person has severe symptoms of microscopic colitis, the doctor might recommend surgery to remove all or part of the colon.

The doctor may also suggest the following additional measures:

• Modifying the drugs one already takes.

• Give up smoking.

• Determining the particular dietary intolerances.

Lifestyle Choices and DIY Solutions

Dietary adjustments may be able to alleviate microscopic colitis and diarrhea

• Drink a Lot of Fluids - Although electrolyte-containing beverages, a combination of sodium and potassium, are desirable, water is still the best option. Swig some diluted fruit juice or broth. Avoid tea, coffee, colas, and any other beverage with a lot of sugar, sorbitol, alcohol, or caffeine. They might make symptoms worse.

• Opt for Foods That are Soft and Easy to Digest - These include applesauce, grains, melons, and bananas. Avoid foods that are heavy in fiber, such as beans and nuts. Eat just cooked vegetables. If a person sees that the symptoms are improving, gradually add high-fiber meals to the diet.

• Eat many small meals as opposed to a few big ones. Meal timing throughout the day may help reduce diarrhea.

• Stay away from meals that irritate the stomach. Foods that exacerbate the symptoms should be avoided, such as fried, hot, greasy, or oily.

Conclusion:

One form of inflammatory bowel disease, or persistent colon inflammation, is microscopic colitis. Along with other gastrointestinal problems, it frequently results in watery diarrhea. When flare-ups happen, diet and medicine can help control them. Some medical professionals advise a low-fat, low-fiber gastrointestinal soft diet to treat the symptoms. The digestive system has less work to do when one consumes less fat and fiber.