Microscopic colitis: Common cause of unexplained nonbloody diarrhea

Abstract

Microscopic colitis (MC) is characterized by chronic, watery, secretory diarrhea, with a normal or near normal gross appearance of the colonic mucosa. Biopsy is diagnostic and usually reveals either lymphocytic colitis or collagenous colitis. The symptoms of collagenous colitis appear most commonly in the sixth decade. Patients report watery, nonbloody diarrhea of a chronic, intermittent or chronic recurrent course. With collagenous colitis, the major microscopic characteristic is a thickened collagen layer beneath the colonic mucosa, and with lymphocytic colitis, an increased number of intraepithelial lymphocytes. Histological workup can confirm a diagnosis of MC and distinguish the two distinct histological forms, namely, collagenous and lymphocytic colitis. Presently, both forms are diagnosed and treated in the same way; thus, the description of the two forms is not of clinical value although this may change in the future. Since microscopic colitis was first described in 1976 and only recently recognized as a common cause of diarrhea, many practicing physicians may not be aware of this entity. In this review, we outline the epidemiology, risk factors associated with MC, its etiopathogenesis, the approach to diagnosis and the management of these individuals.

Keywords: Collagenous colitis; Lymphocytic colitis; Microscopic colitis; Intraepithelial lymphocytes; Thickened collagen band; Diarrhea-predominant irritable bowel syndrome

Core tip: The gastroenterologist and gastrointestinal pathologist should keep this common condition in mind as a cause of unexplained nonbloody diarrhea with normal mucosal appearance on colonoscopy to avoid misdiagnosis that may affect treatment of patients. Referral of patients with pathogen negative chronic diarrhea to medical centers that have facilities for colonoscopy and biopsy is vital in the developing world.