Microscopic Colitis

In patients that complain of long-standing, watery diarrhea, consider Microscopic Colitis.

10-15% of patients with aforementioned symptoms.
Typical profile: Old people with unrevealing gross colonoscopy exam.
MUST biopsy, since the differential includes Celiac and IBS.
Subtypes
- Lymphocytic and Collagenous colitis
Pathophysiology
- Unknown, may be due to PPIs or NSAIDs
- Important! Test for other concomitant diseases, as MC can be found with:
  - Autoimmune: Diabetes (A1C) and/or Psoriasis (look for lesions)
  - Malabsorption: Celiac Sprue
Diagnosis
- Histology of tissue sample: intraepithelial lymphocytosis ( > 20 lymphocytes per 100 epithelial cells)
- Collagenous colitis: beefier subepithelial collagen band.
Treatment
- If medication temporally associated, discontinue offending agent.
- Antidiarrheal – diphenoxylate or loperamide
- Bismuth subsalicylate in moderate disease
- Budesonide in severe/refractory cases.
  - Do not abruptly discontinue due to relapse.

Bibliography

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