By
Ethan Sulliva
A Brief History of Microscopic Colitis
In 1976, Swedish pathologist C.G Lindström discovered a unique condition in the colon he named collagenous colitis. A decade later, in the United States, pathologist A.J. Lazenby described a similar condition he named lymphocytic colitis. Despite their different names, the two conditions exhibited identical symptoms and microscopic tissue changes, leading them to be collectively recognized as microscopic colitis.
Misdiagnosis and Increased Awareness
Initially, microscopic colitis was often mistaken for irritable bowel syndrome (IBS) due to the similarity in symptoms. However, unlike IBS, accurate diagnosis of microscopic colitis requires a detailed examination of the large intestine. Over time, an increase in awareness and access to superior healthcare resources has led to a rise in the diagnosis of microscopic colitis. A comprehensive study in Sweden spanning 25 years (1990-2015) has shown a significant increase in the diagnosis of this condition.
Demographics and Symptoms
Interestingly, the demographics of microscopic colitis are predominantly skewed towards women, with 70% of diagnosed patients being female. Additionally, the average age at diagnosis is around 60 years. Symptoms of microscopic colitis include watery diarrhea, abdominal pain, weight loss, nausea, and in some cases, fecal incontinence. Stress and anxiety related to bowel movements are also common among patients, adding to the complexity of the disease.
Causes and Risk Factors
While the exact cause of microscopic colitis remains unknown, it is understood to be an amalgamation of genetic, environmental, and immune system factors. Smoking is considered a significant risk factor. There are also suspected connections with autoimmune disorders and the use of certain medications. Also, it is believed to have a higher occurrence in patients with IBS, with some studies showing a 23.3% prevalence of microscopic colitis in IBS patients as compared to a 5% prevalence in controls.
Effective Treatment for Microscopic Colitis
Despite the challenges in diagnosis, there are effective treatments available for microscopic colitis. Budesonide, a steroid drug, is often used as a first-line treatment and has been shown to have minimal side-effects. In addition to medical treatments, lifestyle changes such as quitting smoking can also alleviate symptoms and improve the quality of life for patients.
Importance of Proper Diagnosis
With the potential to significantly disturb a patient’s quality of life, it is crucial that microscopic colitis is correctly diagnosed and treated. For patients with suspected diarrhea-predominant IBS whose symptoms are not well controlled by anti-diarrheal therapy, medical professionals are encouraged to explore the possibility of microscopic colitis.
While it may not be necessary for patients younger than 50 years of age with typical IBS symptoms and no alarm features to undergo routine colonic imaging, consideration should be given to obtaining random biopsies when a colonoscopy is performed. This proactive approach could potentially rule out microscopic colitis and ensure that the patient receives the correct treatment.
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