Abstract

  Microscopic colitis is a chronic inflammatory disease of the colon which is characterized by chronic diarrhea, normal colonic mucosa on colonoscopy and abnormal histological findings on random colonic biopsies. When referred for lower GI endoscopy, these patients have normal colonic mucosa on their first colonoscopy but not all of them get random colonic biopsies done. Provided that microscopic colitis has a prevalence of around 48 to 219 per 100,000 and is diagnosed in around 7.5% of all patients undergoing evaluation for chronic diarrhea, it would be strongly advised that all patients with chronic or recurring diarrhea and abdominal pain to get random colonic biopsies during this first lower GI endoscopy even if they are found to have normal colonic mucosa. This approach would have too goals. The first goal is to get the proper diagnosis on their first visit. The second goal is to prevent further colonoscopies and their potential costs and complications if these patient's symptoms do recur in the future without any proper diagnoses after being flagged with functional abdominal pain and normal colonoscopy. Finally, current guidelines from the American Gastroenterological Association Institute on the medical management of microscopic colitis which were published in 2016 are clear and supported by strong evidence [11].

References

1. Pardi DS., et al. “American Gastroenterological Association institute technical review on the medical management of microscopic colitis”. Gastroenterology 150 (2016): 247-274.
2. Lindström CG. ‘Collagenous colitis’ with watery diarrhoea—a new entity?” European Journal of Plant Pathology 11.1 (1976): 87-89.
3. Lazenby AJ., et al. “Lymphocytic (“microscopic”) colitis: a comparative histopathologic study with particular reference to collagenous colitis”. Human Pathology 20.1 (1989): 18-28.
4. Fumery M., et al. “Incidence, Clinical Presentation, and Associated Factors of Microscopic Colitis in Northern France: A Population-Based Study”. Digestive Diseases and Sciences 62.6 (2017):1571-1579.
5. Olesen M., et al. “Lymphocytic colitis: a retrospective clinical study of 199 Swedish patients”. Gut 53.4 (2004): 536-541.
6. Roth B., et al. “Smoking- and alcohol habits in relation to the clinical picture of women with microscopic colitis compared to controls”. BMC Womens Health 14 (2014): 16.
7. Macaigne G., et al. “Microscopic colitis or functional bowel disease with diarrhea: a French prospective multicenter study”. The American Journal of Gastroenterology 109.9 (2014): 1461-1470.
8. Stewart M., et al. “The association of coeliac disease and microscopic colitis: a large population-based study”. Alimentary Pharmacology and Therapeutics 33.12 (2011): 1340-1349.
9. Bohr J., et al. “Collagenous colitis: a retrospective study of clinical presentation and treatment in 163 patients”. Gut 39.6 (1996): 846-851.
10. Masclee GM., et al. "Increased risk of microscopic colitis with use of proton pump inhibitors and non-steroidal anti-inflammatory drugs”. The American Journal of Gastroenterology 110.5 (2015): 749-759.
11. Colitis., et al. “American Gastroenterological Association Institute Guideline on the Medical Management of Microscopic”. Gastroenterology 150.1 (2016): 242-246.
12. Sohaih Abu-Farsakh., et al. “Tingible Body Colitis: A Novel Entity of Colitis Causing Diarrhea”.  American Journal of Clinical Pathology 138.1 (2012): A098. 
13. Drossman DA. “Rome III: the functional gastrointestinal disorders, 3rd ed”. McLean, VA: Degnon Associates (2006):1048.
14. Adam D Farmer and Qasim Aziz. “Mechanisms and management of functional abdominal pain”. Journal of the Royal Society of Medicine 107.9 (2014): 347-354. 
15. Karen Boland and Geoffrey C Nguyen. “Microscopic Colitis: A Review of Collagenous and Lymphocytic Colitis”. Gastroenterology and Hepatology 13.11 (2017): 671-677. 

Citation

Citation: Omar S Mansour. “Microscopic Colitis A Commonly Missed Diagnosis that Needs Further Studies and Thorough Investigations”. Acta Scientific Gastrointestinal Disorders 3.3 (2020): 01-03.

Copyright

Copyright: © 2020 Omar S Mansour. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.