AMITA Health Endoscopy Center Lincoln Park

Microscopic Colitis

Overview

Microscopic colitis causes persistent watery diarrhea caused by inflammation of the colon (large intestine). The inner lining of the colon wall is usually seen with a camera during a colonoscopy or flexible sigmoidoscopy, and it often appears normal to the naked eye. A microscope is needed to evaluate the inflammation in the tissue sample (biopsy) taken during either procedure.

A colonoscopy is performed with a flexible tube with a light, camera, and other tools on the end for taking biopsies. With a colonoscopy, the entire colon can be examined. A flexible sigmoidoscopy uses a shorter tube and only examines the lower part of the colon.

Different types of microscopic colitis can have either a thick layer of protein (collagen) in the inner colon lining, white blood cells in the lining, or a mixture of both. Regardless, the symptoms, testing and treatment are the same for each type.

Risk factors for developing microscopic colitis include age 50 to 70, smoking, genetics, being a woman, or an autoimmune diagnosis such as rheumatoid arthritis or type 1 diabetes. Several medications may be linked to developing the diagnosis, such as anti-inflammatories (ibuprofen, aspirin, naproxen), proton pump inhibitors (PPIs) such as lansoprazole (Prevacid) or esomeprazole (Nexium), and various others.

Symptoms

  • Persistent watery diarrhea
  • Abdominal pain, cramps or bloating
  • Nausea
  • Loss of control of stool (fecal incontinence)
  • Dehydration
  • Weight loss

Treatments

Diet. Eat a low-fat, low-fiber diet. Avoiding dairy products and gluten may also help. You should avoid sugar and caffeine.

Stop medications. Various medications may be causing your symptoms; ask your provider which ones to potentially discontinue or replace.

Try medications. Medications that may help include:

  • Anti-diarrheal medications such as bismuth subsalicylate (Pepto-Bismol) or loperamide (Imodium)
  • Medications that block bile acids, such as colestipol (Colestid)
  • Oral steroids
  • Tumor necrosis factor (TNF) inhibitors such as infliximab (Remicade)
  • Medications that suppress the immune system, such as azathioprine (Imuran)
  • Anti-inflammatory medications to help control colon inflammation such as mesalamine (Delzicol)

Surgery. Surgery is rarely needed, but in severe cases that do not respond to other treatments, part of the colon may be removed.

Prevention

Avoid irritating foods. Spicy, fatty and fried foods may worsen your symptoms.

Eat soft and easy-to-digest foods. Include bananas, rice, melons and well-cooked vegetables in your diet. Avoid high-fiber foods such as nuts and beans. If your symptoms improve, you may try slowly adding high-fiber foods back into your diet.

Control portion size. Try eating several small meals throughout the day — it may lessen your diarrhea.

Drink plenty of fluids. Drink water, electrolyte drinks (with added potassium and sodium), watered-down fruit drinks or broths. Avoid sweet beverages that are high in sugar or sorbitol, alcohol, and caffeinated drinks such as colas, coffee and tea.