Microscopic colitis is a type of bowel disease of the intestines. It’s far more common in older individuals and often leads to gut symptoms such as chronic watery diarrhoea and pain in the abdomen.
There are 2 types of this condition (referred to as subtypes). These are lymphocytic colitis ad collagenous colitis. While symptoms are similar when the gut cells are viewed under a microscope there are specific differences in each type [Source: Pubmed].
Symptoms of Microscopic Colitis
The symptoms of the type of inflammatory bowel condition also appear in other types of gut issues such as IBS and SIBO.
The common gut symptoms of Microscopic Colitis include:
- Watery non-bloody diarrhoea
- The need for a bowel movement during the night
- Faecal urgency (the need to get to the toilet quickly)
- Abdominal pain (tummy ache)
- Weight loss
- Arthralgias (joint pain)
While all of these may be common and can appear, their severity is variable between individuals. The same is also true for the courses of the gut condition. For some, symptoms appear occasionally while for others they can be chronic and ongoing. [Source: Pubmed]
Is smoking bad for Microscopic Colitis?
Studies from North America and Europe conclude the increase in cases of this gut condition. Certain factors that increase the risk of the condition we also reported, smoking included.
| Risk Factors | Associations |
| Demographic characteristics | More common overall in middle-aged to older patients and women |
| Medications | Proton pump inhibitors, selective serotonin reuptake inhibitors, nonsteroidal anti-inflammatory drugs, H2 receptor blockers, statins, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers |
| Autoimmune diseases | Associated conditions include rheumatoid arthritis, hypothyroidism and hyperthyroidism, celiac disease, and diabetes mellitus, among others |
| Smoking | increases frequency of watery stools and decreases the likelihood of achieving clinical remission |
What causes Microscopic colitis?
The exact cause of this gut issue is not fully understood. However, there are theories about what might be leading to symptoms.
These include:
- Autoimmunity
- Genetics
- Immune and inflammatory response to the contents of the gut
- The use of certain medications
- Changes in collagen metabolism [Source: Pubmed]
Also Read: What Is Pancolitis? Symptoms, Causes & Treatment
Microscopic colitis and autoimmunity
Microscopic colitis is common in those with autoimmune conditions.
These include:
- Hypothyroidism
- Hyperthyroidism
- Coeliac disease
- Rheumatoid arthritis
- Type 1 diabetes
While microscopic colitis is more common in the female population, as are autoimmune conditions generally, there is not an antibody blood test that indicates this is an autoimmune condition. [Source: Pubmed]
Microscopic colitis and gut health
Another potential cause for symptoms is the immune response to the contents of the gut. The changes in the immune response in the gut (and the resulting inflammation) may target compounds travelling through the digestive tract.
The immune system can potentially over respond to:
- Food components (eg proteins from food)
- Bile salts
- Medications
- Bacterial toxins (potentially due to imbalances in the gut bacteria)
Bacterial changes in the gut have been noted to impact both the immune system and levels of inflammation. To reinforce this, antibiotics have been indicated as an option to reduce the severity of symptoms in some with microscopic colitis. [Source: Pubmed]
Microscopic colitis and gut bacteria
When compared with healthy individuals those with microscopic colitis has a reduced number of the beneficial gut bacteria Akkermansia. This organism helps to support the strength and integrity of the gut lining by supporting the amount of protective mucus along the gut wall.
The understanding is that if this organism is depleted that the immune system is in closer contact with the contents of the gut which may then trigger a response that leads to gut symptoms. [Source: Pubmed]
Microscopic colitis and Coeliac disease
Microscopic colitis is more common in those with Coeliac disease and similar changes in the gut lining have been noted in Coeliac patients who consume gluten.
A similar change in the gut lining has been noted in those with bile acid malabsorption. A possible explanation while medications that bind to bile acids are helpful in a small group of those with Microscopic colitis. [Source: Pubmed]
How is Microscopic colitis diagnosed?
When viewed via a colonoscopy (a camera) the lining of the large intestine appears normal. This is the reason that a diagnosis required the evaluation of a biopsy sample taken from this.
This evaluates the microscopic levels of inflammation present in the gut lining that is understood to contribute to the symptoms of this gut condition. [Source: Pubmed]
Best diet for Microscopic colitis
Due to the chronic diarrhoea and associated fluid loss, electrolytes and fluid replacement are important in the condition.
Additionally, certain foods may best be avoided for a period of time to see if symptoms improve.
These include:
- Lactose
- Alcohol
- Caffeine
- Spicy food
Sensitivities to other foods may also be present which may need to be assessed through further testing or trailing an elimination diet.
Due to the research carried out on the specific carbohydrate diet (SCD) and inflammatory bowel disease (IBD), this may be a key way to assess for sensitivities and improve the health of the gut.
One study into this diet’s usage in IBD lead to an improvement in symptoms, blood test results as well as improvements in the balance of the beneficial gut bacteria [Source: Pubmed]
Boswellia Serrata Extract for Microscopic colitis
Over a 6-week period, a study using an extract of the herb Boswellia Serrata lead to higher rates of clinical remission than the group given the placebo.
This included a reduction in the frequency of bowel movements with an average reduction from 6.5 bowel movements per day to 3 bowel movements per day. [Source: Pubmed]
Probiotics for Microscopic colitis
The combination of 2 probiotic strains (Lactobacillus acidophilus LA-5 and Bifidobacterium animalis subsp. lactis BB-12) we were shown to improve symptoms of this gut condition.
Perhaps most notably a reduction in the number of days with diarrhoea per week. This improved from 6 days with diarrhoea per week to 1 day per week [Source: Pubmed]
Colostrum for Microscopic colitis
Bovine colostrum has been studied for its ability to support the gut microbiome, anti-inflammatory processes and immune response in the gut.
However, further studies are required to clarify the immunomodulatory mechanisms that can prevent the development and the progression of chronic inflammation in inflammatory bowel conditions. [Source: Pubmed]
Conclusion
While there are many factors that can lead to the onset of this condition and many more that can help reduce symptoms there is not a 1 size fits all approach to this gut issue.
Working with a specialist in this area can help you reach a symptom-free life.
