Microscopic colitis: Difference between revisions
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==Overview== | ==Overview== | ||
'''Microscopic colitis''' refers to two medical conditions which cause [[diarrhoea]]: [[collagenous colitis]] and [[lymphocytic colitis]]. Both conditions are characterised by the following triad of clinicopathological features: | '''Microscopic colitis''' refers to two medical conditions which cause [[diarrhoea]]: [[collagenous colitis]] and [[lymphocytic colitis]]. Both conditions are characterised by the following triad of clinicopathological features: | ||
# Chronic watery diarrhoea; | # Chronic watery diarrhoea; | ||
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# Characteristic [[histopathology]]. | # Characteristic [[histopathology]]. | ||
== | ==Historical Perspective== | ||
==Classification== | |||
== | ==Pathophysiology== | ||
The hallmark of microscopic colitis is an increase in inflammatory cells (i.e. [[lymphocytes]]) in colonic [[biopsies]] with an otherwise normal appearance and architecture of the colon. Inflammatory cells are increased both in the surface [[epithelium]] ("intraepithelial lymphocytes") and in the [[lamina propria]]. In lymphocytic colitis, these are the only abnormal features. | The hallmark of microscopic colitis is an increase in inflammatory cells (i.e. [[lymphocytes]]) in colonic [[biopsies]] with an otherwise normal appearance and architecture of the colon. Inflammatory cells are increased both in the surface [[epithelium]] ("intraepithelial lymphocytes") and in the [[lamina propria]]. In lymphocytic colitis, these are the only abnormal features. | ||
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Microscopic colitis in some cases may be an adverse reaction to drugs or an autoimmune disorder.<ref name="pmid25001258">{{cite journal| author=Macaigne G, Lahmek P, Locher C, Lesgourgues B, Costes L, Nicolas MP et al.| title=Microscopic colitis or functional bowel disease with diarrhea: a French prospective multicenter study. | journal=Am J Gastroenterol | year= 2014 | volume= 109 | issue= 9 | pages= 1461-70 | pmid=25001258 | doi=10.1038/ajg.2014.182 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25001258 }} </ref> | Microscopic colitis in some cases may be an adverse reaction to drugs or an autoimmune disorder.<ref name="pmid25001258">{{cite journal| author=Macaigne G, Lahmek P, Locher C, Lesgourgues B, Costes L, Nicolas MP et al.| title=Microscopic colitis or functional bowel disease with diarrhea: a French prospective multicenter study. | journal=Am J Gastroenterol | year= 2014 | volume= 109 | issue= 9 | pages= 1461-70 | pmid=25001258 | doi=10.1038/ajg.2014.182 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25001258 }} </ref> | ||
== | ==Causes== | ||
==Differentiating Microscopic Colitis from other Diseases== | |||
==Epidemiology and Demographics== | |||
== | ===Age=== | ||
Patients are characteristically middle-aged. | |||
===Gender=== | |||
Patients are characteristically, though not exclusively female. | |||
===Race=== | |||
== | ==Risk Factors== | ||
== | ==Natural History, Complications and Prognosis== | ||
{{ | The prognosis for lymphocytic colitis and collagenous colitis is good and both conditions are considered to be benign.<ref name=mullhaupt>{{cite journal | author = Mullhaupt B, Güller U, Anabitarte M, Güller R, Fried M | title = Lymphocytic colitis: clinical presentation and long term course. | journal = Gut | volume = 43 | issue = 5 | pages = 629-33 | year = 1998 | id = PMID 9824342}}</ref> The majority of people afflicited with the conditions recover from their diarrhoea and their histological abnormalities resolve.<ref name=fernandez/> | ||
== | ==Diagnosis== | ||
===Diagnostic Criteria=== | |||
===Symptoms=== | |||
===Physical Examination=== | |||
===Laboratory Findings=== | |||
===Imaging Findings=== | |||
===Other Diagnostic Studies=== | |||
Colonoscopy is normal or near normal. The changes are often patchy, so multiple colonic biopsies must be taken in order to make the diagnosis. A full colonoscopy is required, as an examination limited to the rectum will miss cases of microscopic colitis. | |||
==Treatment== | |||
===Medical Therapy=== | |||
No single treatment is accepted as the standard and measuring response is difficult. Often a trial of [[anti-diarrhoeal]]s is followed by [[anti-inflammatory drug]]s. | |||
Lymphocytic colitis is thought to respond well to [[mesalazine]] and collagenous colitis to [[budesonide]].<ref name=fernandez>{{cite journal | author = Fernández-Bañares F, Salas A, Esteve M, Espinós J, Forné M, Viver J | title = Collagenous and lymphocytic colitis. evaluation of clinical and histological features, response to treatment, and long-term follow-up. | journal = Am J Gastroenterol | volume = 98 | issue = 2 | pages = 340-7 | year = 2003 | id = PMID 12591052}}</ref> | |||
===Surgery=== | |||
===Prevention=== | |||
[[ | ==References== | ||
{{Reflist|2}} | |||
[[Category:Needs content]] | |||
[[Category:Rheumatology]] | |||
[[Category:Disease]] | |||
{{WH}} | {{WH}} | ||
{{ | {{WS}} | ||
Latest revision as of 20:31, 5 July 2016
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Synonyms and keywords:
Overview
Microscopic colitis refers to two medical conditions which cause diarrhoea: collagenous colitis and lymphocytic colitis. Both conditions are characterised by the following triad of clinicopathological features:
- Chronic watery diarrhoea;
- Normal colonoscopy;
- Characteristic histopathology.
Historical Perspective
Classification
Pathophysiology
The hallmark of microscopic colitis is an increase in inflammatory cells (i.e. lymphocytes) in colonic biopsies with an otherwise normal appearance and architecture of the colon. Inflammatory cells are increased both in the surface epithelium ("intraepithelial lymphocytes") and in the lamina propria. In lymphocytic colitis, these are the only abnormal features.
In collagenous colitis, the features of lymphocytic colitis are present, with in addition the presence of a thickened subepithelial collagen layer which may be up to 30 micrometres thick.
Microscopic colitis in some cases may be an adverse reaction to drugs or an autoimmune disorder.[1]
Causes
Differentiating Microscopic Colitis from other Diseases
Epidemiology and Demographics
Age
Patients are characteristically middle-aged.
Gender
Patients are characteristically, though not exclusively female.
Race
Risk Factors
Natural History, Complications and Prognosis
The prognosis for lymphocytic colitis and collagenous colitis is good and both conditions are considered to be benign.[2] The majority of people afflicited with the conditions recover from their diarrhoea and their histological abnormalities resolve.[3]
Diagnosis
Diagnostic Criteria
Symptoms
Physical Examination
Laboratory Findings
Imaging Findings
Other Diagnostic Studies
Colonoscopy is normal or near normal. The changes are often patchy, so multiple colonic biopsies must be taken in order to make the diagnosis. A full colonoscopy is required, as an examination limited to the rectum will miss cases of microscopic colitis.
Treatment
Medical Therapy
No single treatment is accepted as the standard and measuring response is difficult. Often a trial of anti-diarrhoeals is followed by anti-inflammatory drugs.
Lymphocytic colitis is thought to respond well to mesalazine and collagenous colitis to budesonide.[3]
Surgery
Prevention
References
- ↑ Macaigne G, Lahmek P, Locher C, Lesgourgues B, Costes L, Nicolas MP; et al. (2014). "Microscopic colitis or functional bowel disease with diarrhea: a French prospective multicenter study". Am J Gastroenterol. 109 (9): 1461–70. doi:10.1038/ajg.2014.182. PMID 25001258.
- ↑ Mullhaupt B, Güller U, Anabitarte M, Güller R, Fried M (1998). "Lymphocytic colitis: clinical presentation and long term course". Gut. 43 (5): 629–33. PMID 9824342.
- ↑ 3.0 3.1 Fernández-Bañares F, Salas A, Esteve M, Espinós J, Forné M, Viver J (2003). "Collagenous and lymphocytic colitis. evaluation of clinical and histological features, response to treatment, and long-term follow-up". Am J Gastroenterol. 98 (2): 340–7. PMID 12591052.