Microscopic colitis can only be diagnosed by colonoscopy and mucosal biopsy because, macroscopically, the colon appears normal.
The incidence is increasing as the use of colonoscopy increases - almost certainly due to better diagnostic workup.
Microscopic colitis is diagnosed in up to 10% of all patients undergoing colonoscopy for unexplained diarrhoea, an incidence which increases to 20% in those aged over 70 years.
Microscopic colitis can be diveded into two subcategories: collageneous and lymphocytic colitis.
Histological findings:
Collangeneous colitis: increase in the colonic mucosal subepithial collagen layer , a collagen of > 10 um thick, usually type I or III.
Lymphocytic colitis: increased numbers of interepithial lymphocytes > 20 / epithelial cells ( 4-5 in IBD).
Microscopic colitis can be diveded into two subcategories: collageneous and lymphocytic colitis.
Histological findings:
Collangeneous colitis: increase in the colonic mucosal subepithial collagen layer , a collagen of > 10 um thick, usually type I or III.
Lymphocytic colitis: increased numbers of interepithial lymphocytes > 20 / epithelial cells ( 4-5 in IBD).
Budesonide is the most effective and widely studied agent for inducing (and maintaining) remission in microscopic colitis. It is likely to be more effective (and certainly less toxic) than oral prednisolone.
There is conflicting data on the association between bile acid malabsorption (BAM) and microscopic colitis though more data supports an association. Where present BAM (unsurprisingly) worsens diarrhoea. Cholestyramine is recommended where there is BAM however there IS evidence that even patients without BAM may respond to cholestyramine therapy.
Use of 5-ASA compounds with or without cholestyramine has generated high remission rates (85-91%). Most treatment algorithms suggest a graded approach starting with anti-diarrhoeal agents, cholestyramine and 5-ASAs. More severe (such as here) or non-responsive disease should be treated with budesonide in the first instance and bismuth in the second.
Lymphocytic colitis, characterized by increased numbers of intraepithelial lymphocytes and inflammatory infiltrate in the lamina propria.
A 75-year-old patient presents with watery diarrhoea.
ReplyDeleteHe is passing large volumes of watery diarrhoea, approximately 3 litres a day, with no noticeable blood. It has been present for approximately five months and is gradually becoming more frequent. It often wakes him at night with the urge to defecate.
Liver function tests, calcium and urea and electrolytes are normal. Stool microscopy and culture are normal, and Clostridium difficile toxin is negative.
A flexible sigmoidoscopy is organised and the investigator reports to you that the large bowel appears normal.
From which of the following treatments may this patient benefit?
(Please select 1 option)
1-Gluten free diet
2-Low residue diet
3-Oral budesonide
4-Oral cholestyramine
5-Oral prednisolone
In the absence of infection and with this typical history in an elderly individual the diagnosis is likely to be microscopic colitis.
This does not fulfil the ROME II criteria for IBS.
Although coeliac disease is a possibility this is unlikely given the patient's age, and the presentation.
Microscopic colitis can only be diagnosed by colonoscopy and mucosal biopsy because, macroscopically, the colon appears normal.
The incidence is increasing as the use of colonoscopy increases - almost certainly due to better diagnostic workup. Microscopic colitis is diagnosed in up to 10% of all patients undergoing colonoscopy for unexplained diarrhoea, an incidence which increases to 20% in those aged over 70 years.
Budesonide is the most effective and widely studied agent for inducing (and maintaining) remission in microscopic colitis. It is likely to be more effective (and certainly less toxic) than oral prednisolone.
There are conflicting data on the association between bile acid malabsorption (BAM) and microscopic colitis though more data support an association. Where present BAM (unsurprisingly) worsens diarrhoea.
Cholestyramine is recommended where there is BAM however there is evidence that even patients without BAM may respond to cholestyramine therapy. Use of 5-ASA compounds with or without cholestyramine has generated high remission rates (85-91%).
Most treatment algorithms suggest a graded approach starting with antidiarrhoeal agents, cholestyramine and 5-ASAs. More severe (such as here) or non-responsive disease should be treated with budesonide in the first instance and bismuth in the second.
Which of the following clinical and laboratory features are most consistent with a diagnosis of collagenous and lymphocytic colitis?
ReplyDelete1-Fresh stools showed fecal leukocytes in 55% of cases of collagenous colitis.
2-Diarrhea is generally long-standing, with an average of eight stools each day.
3-Colonoscopic examination usually is normal.
4-More common in women
5-All of the above
Patients with collagenous and lymphocytic colitis usually present with chronic watery diarrhea with an average of eight stools each day. Examination of fresh stools showed fecal leukocytes in 55% of 116 patients with collagenous colitis. Although nonspecific abnormalities including patchy edema, erythema, and friability are observed, findings of a colonoscopic examination are usually normal.
I was diagnosed as HEPATITIS B carrier in 2013 with fibrosis of the
ReplyDeleteliver already present. I started on antiviral medications which
reduced the viral load initially. After a couple of years the virus
became resistant. I started on HEPATITIS B Herbal treatment from
ULTIMATE LIFE CLINIC (www.ultimatelifeclinic.com) in March, 2020. Their
treatment totally reversed the virus. I did another blood test after
the 6 months long treatment and tested negative to the virus. Amazing
treatment! This treatment is a breakthrough for all HBV carriers.