Lymphocytic Colitis (cont.)
How is microscopic colitis diagnosed?
The diagnosis of microscopic colitis is made by performing biopsies from
different regions of the colon during colonoscopy or sigmoidoscopy.
The abnormalities of the colon's lining in microscopic
colitis occur in a patchy distribution (areas of normal lining may exist
adjacent to areas of abnormal lining). For this reason, multiple biopsies should
be taken from several different regions of the colon in order to accurately make
a diagnosis. The patchy nature of microscopic colitis also is the reason why
flexible sigmoidoscopy often is inadequate in diagnosing the condition because
the abnormalities of microscopic colitis may be absent from the sigmoid colon
(the colonic segment that is closest to the rectum and is within the reach of a
sigmoidoscope) in 30-40% of the patients with microscopic
colitis. Thus, biopsies of other regions of the colon accessible only with
colonoscopy may be necessary for diagnosing microscopic colitis.
What is the prognosis of microscopic colitis?
The long term prognosis (course) of microscopic colitis is not clear. In
approximately two-thirds of the patients with microscopic colitis, the diarrhea
resolves spontaneously after several years. The remaining one-third of the
patients experience persistent or intermittent diarrhea for many years (possibly
indefinitely).
What is the treatment for microscopic colitis?
The treatment of microscopic colitis has not been standardized because there
have not been adequate large scale, prospective, placebo controlled treatment
trials. The following strategies are safe and may relieve diarrhea in some
patients:
- Avoid NSAIDs
- Trial of lactose elimination (just to eliminate the
possibility that intolerance to lactose
in milk is aggravating the
diarrhea)
- Anti-diarrhea agents such as Imodium or Lomotil
- Bismuth subsalicylate such as Pepto-Bismol
- 5-ASA (mesalamine) compounds such as Asacol, Pentasa, or Colazal
Two recent, controlled trials showed that budesonide
(Entocort, a poorly absorbed steroid) is effective in controlling diarrhea in
more than 75% of the patients with collagenous colitis, but the diarrhea tends
to recur soon after
stopping Entocort.
Though data is lacking, some doctors may consider using
medications that potently suppress the immune system such as azathioprine and 6-mercaptopurine
among patients with severe microscopic colitis that is unresponsive to other
treatments.
Last Editorial Review: 4/19/2005
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