Know all about microscopic colitis which is often misdiagnosed as the more common Irritable Bowel Syndrome.
Microscopic colitis is marked by abdominal pain and persistent watery diarrhea. (iStock)
The life of a 48-year-old teacher from Bengaluru was thrown completely out of gear when she began experiencing persistent and watery diarrhea, accompanied by abdominal bloating and discomfort.
Holding down her job or attending any kind of social gathering became difficult as she had to rush to the loo as soon as she ate anything.
Her physician had a straightforward diagnosis. The doctor said it was simply Irritable Bowel Syndrome (IBS) and prescribed medications to manage her symptoms.
However, despite adhering to the prescribed treatment plan, the woman’s symptoms only worsened with time, affecting just about every aspect of her life.
In desperation, she changed doctors and finally consulted a gastroenterologist at a private city hospital.
The diagnosis this time was different: Microscopic colitis, an uncommon disease that often goes undiagnosed — or misdiagnosed — and can significantly impact the lives of those who have it.
According to doctors, microscopic colitis is a type of Inflammatory Bowel Disease (IBD) the cause of which is still not entirely clear.
Its most common symptom is chronic, watery, diarrhea (without any blood). It is also marked by diarrhea that occurs at night, abdominal pain, fecal incontinence, an uncontrollable need to have bowel movement, weight loss, and fatigue.
“We routinely see other spectrum of IBD, classically ulcerative colitis, and Crohn’s disease. Though this entity is not very frequent, Manipal being a tertiary referral center for gastrointestinal (GI) disorders, we see a fair share of the disease in our practice,” said Dr Manjunath Haridas, Consultant of Colorectal and GI Surgery at Manipal Hospital, Whitefiled, Bengaluru.
One of the distinct features of microscopic colitis is that the inner lining of the large intestine appears normal during colonoscopy.
Hence, accurate diagnosis requires taking tissue samples for biopsy and examination under a microscope, according to Dr Rajeev Jayadevan, MD, with an American Board Certification in Gastroenterology.
“This disease can commonly be missed, and underdiagnosis is the most common reason why this entity is overlooked,” explained Dr Haridas.
“It is frequently mistaken for IBS due to similar symptoms such as diarrhea, abdominal bloating, and discomfort. However, a biopsy is the differentiating factor,” he told South First, emphasising the importance of consulting a good histopathologist experienced in diagnosis and GI pathology.
There are broadly two types of microscopic colitis — the collagenous type and the lymphocytic colitis.
It can be triggered by infections and certain medications, including painkillers and antidepressants. It can co-exist with some auto immune diseases and is more common among women. Making a correct diagnosis is therefore important, Dr Jayadevan told South First, adding that the disease may require long-term follow-up with a doctor.
Microscopic colitis primarily affects the elderly population, especially those who are over 60. However, it has been seen in patients in their 40s and even in children, said Dr Haridas.
He also highlighted the increased preponderance of microscopic colitis in patients with autoimmune diseases such as Type 1 diabetes, rheumatoid arthritis, polyarthritis, thyroditis, and other immune-mediated diseases.
Interestingly, doctors are of late noticing that, post-Covid-19 vaccination, there has been a rise in features similar to microscopic colitis in some patients. Dr Haridas, however, pointed out it is a self-limiting disease and does not lead to other digestive issues.
Steroids play a crucial role in the treatment of microscopic colitis, serving as the mainstay of therapy. As the condition is, most of the time, immune-mediated, immune modulators like Mesalamine and Methotrexate are used to in the treatment.
Additionaly, symptomatic control can be achieved through the use of bile salts (Cholesyetramine) Bismuth Subsalicylate and Thiopurine.
“In rare situaitons, TNF inhibitors have also been used with good results,” added Dr Haridas. Tumor Necrosis Factor (TNF) Inhibitors are drugs that help control inflammation.
Given the potential for misdiagnosis and the impact on patients’ quality of life, accurate identification of microscopic colitis is crucial.
Dr Haridas underscored the significance of long-term follow up with healthcare professionals to monitor the condition and ensure appropriate treatment adjustments, if necessary.
“In our practice, we routinely perform high-resolution colonoscopies and biopsies to avoid overlooking such disorder,” said Dr Haridas.
“Collaboration between gastroenterologists, histopathologists,and patients is the key to managing microscopic clitis effectively,” he added.
Making the correct diagnosis could mark the turning point in lives of those suffering from miscroscopic colitis, stressed Dr Jayadevan.
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