I was thirty-six when my colitis started. I was in a hospital for anorexia, and was going through what they called “the refeeding process.” This was way before I had my feeding tube so I was still taking all my nutrition by mouth. The process was slow because I was so emaciated and had not been eating much for months. But I was willing and compliant, and ate at least 90% of the prescribed meals on my plan. After a month of gradually increasing the portions I had only gained a couple of pounds, but I was feeling stronger and was less depressed. Then one morning I went to the bathroom to empty my bowels and an explosion of diarrhea came out. I immediately told the nurse, but didn’t think much of it, since I wasn’t feeling sick otherwise.
When the watery explosions persisted for three more days, the doctors did some stool cultures and blood work. They said I had an infection for which I was given an antibiotic called metronidazole. I stayed on that for 2 weeks, but the diarrhea continued. They doctors didn’t have an explanation. All they could do was keep me on a bland diet.
I stayed in that hospital for 5 months and gained 17 pounds, but when I was discharged I was still having 3-4 episodes of watery diarrhea every day. When I was discharged, and went home to Los Angeles to be with my husband and dogs, I felt better because I’d gained weight, but didn’t know what to do about my poop problem. After visiting a few gastroenterologists I was referred to the God of Gastro doctors at UCLA, and he said, “Ms Thompson, we’re going to throw the book at you.” And he did. I went through every test imaginable and he finally came up with a diagnosis of “collagenous” or “microscopic” colitis. I was then put on a lot more drugs, including tincture of opium and prednisone. I got some relief, but to this day I still have daily accidents. This led to my need for a feeding tube. Please visit my Feeding Tube page for more info.
What is microscopic colitis?
Microscopic colitis is an inflammation of the colon that a health care provider can see only with a microscope. Inflammation is the body’s normal response to injury, irritation, or infection of tissues. Microscopic colitis is a type of inflammatory bowel disease—the general name for diseases that cause irritation and inflammation in the intestines.
The two types of microscopic colitis are collagenous colitis and lymphocytic colitis. Health care providers often use the term microscopic colitis to describe both types because their symptoms and treatments are the same.
In both types of microscopic colitis, an increase in the number of lymphocytes, a type of white blood cell, can be seen in the epithelium—the layer of cells that lines the colon. An increase in the number of white blood cells is a sign of inflammation. The two types of colitis affect the colon tissue in slightly different ways:
- Lymphocytic colitis. The number of lymphocytes is higher, and the tissues and lining of the colon are of normal thickness.
- Collagenous colitis. The layer of collagen, a threadlike protein, underneath the epithelium builds up and becomes thicker than normal.
When looking through a microscope, the health care provider may find variations in lymphocyte numbers and collagen thickness in different parts of the colon. These variations may indicate an overlap of the two types of microscopic colitis.
How is microscopic colitis treated?
Treatment depends on the severity of symptoms. The gastroenterologist will
- review the medications the person is taking
- make recommendations to change or stop certain medications
- recommend that the person quit smoking
The gastroenterologist may prescribe medications to help control symptoms. Medications are almost always effective in treating microscopic colitis. The gastroenterologist may recommend eating, diet, and nutrition changes. In rare cases, the gastroenterologist may recommend surgery.
The gastroenterologist may prescribe one or more of the following:
- antidiarrheal medications such as bismuth subsalicylate (Kaopectate, Pepto-Bismol), diphenoxylate/atropine (Lomotil), and loperamide
- corticosteroids such as budesonide (Entocort) and prednisone
- anti-inflammatory medications such as mesalamine and sulfasalazine (Azulfidine)
- cholestyramine resin (Locholest, Questran)––a medication that blocks bile acids
- antibiotics such as metronidazole (Flagyl) and erythromycin
- immunomodulators such as mercaptopurine (Purinethol), azathioprine (Azasan, Imuran), and methotrexate (Rheumatrex, Trexall)
- anti-TNF therapies such as infliximab (Remicade) and adalimumab (Humira)
Corticosteroids are medications that decrease inflammation and reduce the activity of the immune system. These medications can have many side effects. Scientists have shown that budesonide is safer, with fewer side effects, than prednisone. Most health care providers consider budesonide the best medication for treating microscopic colitis.
Patients with microscopic colitis generally achieve relief through treatment with medications, although relapses can occur. Some patients may need long-term treatment if they continue to have relapses.