microscopic colitis
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Etiology
- pharmaceuticals[2]
- likely
- less likely
- unlikely
- association with celiac disease[3]
* predictors of microscopic colitis vs functional diarrhea
- autoimmune disease
- starting a new drug < 3 months prior to diarrhea onset
- age >50
- weight loss
- duration of diarrhea <12 months[5]
Epidemiology
- most commonly occurs in middle-age (45-60 years) & elderly women
- 10-15% of patients with secretory chronic diarrhea
Pathology
- abnormal immune reaction to luminal antigens in predisposed hosts[3]
- infiltration of lamina propria with inflammatory cells & intraepithelial lymphocytes (> 20/100 epithelial cells)
- subepithelial collagen band in the lamina propria > 10 mm
Clinical manifestations
- presents with painless watery chronic diarrhea
- non-bloody secretory diarrhea
- sometimes abdominal discomfort & weight loss
Laboratory
- serum tissue transglutaminase IgA to rule out celiac disease if unresponsive to therapy[2]
Diagnostic procedures
Complications
- no increased risk of colorectal cancer
Management
- stop offending drug(s)
- supportive treatment
- budesonide first-line for symptomatic colitis
- mesalamine, bismuth salicylate, or prednisone if budesonide not an option[6]
- do not treat patients with probiotics or Boswellia serrata[6]
- do not add cholestyramine to mesalamine monotherapy[6]
More general terms
More specific terms
Additional terms
References
- ↑ Harrison's Principles of Internal Medicine, 13th ed. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 218
- ↑ 2.0 2.1 2.2 2.3 Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18, 19. American College of Physicians, Philadelphia 2009, 2012, 2015, 2018, 2021.
Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022 - ↑ 3.0 3.1 3.2 Beaugerie L, Pardi DS Review article: drug-induced microscopic colitis - proposal for a scoring system and review of the literature. Aliment Pharmacol Ther. 2005 Aug 15;22(4):277-84. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16097993
- ↑ Williams JJ, Beck PL, Andrews CN, Hogan DB, Storr MA. Microscopic colitis - a common cause of diarrhoea in older adults. Age Ageing. 2010 Mar;39(2):162-8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20065357
- ↑ 5.0 5.1 5.2 5.3 5.4 Macaigne G et al. Microscopic colitis or functional bowel disease with diarrhea: A French prospective multicenter study. Am J Gastroenterol 2014 Sep; 109:1461 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25001258
- ↑ 6.0 6.1 6.2 6.3 6.4 Nguyen GC et al. American Gastroenterological Association Institute guideline on the medical management of microscopic colitis. Gastroenterology 2015 Nov 14 PMID: https://www.ncbi.nlm.nih.gov/pubmed/26584605
- ↑ Pardi DS, Kelly CP. Microscopic colitis. Gastroenterology. 2011 Apr;140(4):1155-65. Epub 2011 Feb 22. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21303675
- ↑ 8.0 8.1 8.2 Verhaegh BP, de Vries F, Masclee AA et al. High risk of drug-induced microscopic colitis with concomitant use of NSAIDs and proton pump inhibitors. Aliment Pharmacol Ther 2016 Mar 9 PMID: https://www.ncbi.nlm.nih.gov/pubmed/26956016
- ↑ Pardi DS. Diagnosis and Management of Microscopic Colitis. Am J Gastroenterol. 2017 Jan;112(1):78-85. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27897155
- ↑ Pardi DS, Tremaine WJ, Carrasco-Labra A. American Gastroenterological Association Institute Technical Review on the Medical Management of Microscopic Colitis. Gastroenterology. 2016 Jan;150(1):247-274.e11. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26584602
- ↑ 11.0 11.1 11.2 NEJM Knowledge+ Gastroenterology