Microscopic colitis in older adults: impact, diagnosis, and management

Abstract

Microscopic colitis (comprising lymphocytic and collagenous colitis, albeit an incomplete variant is gaining recognition as well) is a chronic, immune-mediated inflammatory state of the lower gastrointestinal tract (colon). The diagnosis requires diagnostic colonoscopy with characteristic histopathological findings. They have a propensity to present in senior populations (above 60 years of age), particularly women – who are approximately 2.5–3 times more likely to develop microscopic colitis. Preexisting other immune-inflammatory diseases are also shown to predispose patients for the development of microscopic colitis. The classic presentation is profuse watery diarrhea, often during the night or early morning hours. Fecal incontinence and abdominal pain are frequent as well. Thus, the disease impacts patients’ quality of life and well-being. The first described cases date back to the seventies and eighties of the twentieth century, thereby they can be considered fairly recently discovered disease states. Our understanding of the disease and its pathophysiology is still incomplete. Although there is a lack of unified recommendation for treatment, most clinicians prefer the use of budesonide, and most published guidelines regard this locally acting glucocorticoid as the therapy of choice. In our article, we aimed for a brief, noncomprehensive overview of the clinical significance, diagnosis, and management of microscopic colitis.

Differential diagnosis of ulcerative colitis with increased diarrhea; collagenous colitis or irritable bowel syndrome? A case report

“…There are also many reports of the usefulness of steroids in similar cases. 20 This report raises important issues in that IBD patients could develop CC despite successful UC treatment clinically and with remission shown endoscopically. Such patients are likely to be initially misdiagnosed as having diarrhea-predominant irritable bowel syndrome (IBS-D) before a biopsy is obtained and analyzed.…”

Warning to Delay in Diagnosing Microscopic Colitis in Older Adults. A Series of Cases

“…IBS commonly appears before the age of 50, with the consistency of stools varying from soft to hard, and abdominal pain accompanied by a sense of incomplete evacuation. However, fecal incontinence and weight loss may assist in distinguishing IBS from MC (4,8,9) . Celiac disease must be eliminated in the differential diagnosis of MC, as the link between these two disorders have been previously described (17) All cases in our study had normal IgA serum levels, negative serum autoantibodies and normal histopathology of duodenal mucosa, excluding CeD.…”

“…The etiology is unknown, and the pathogenesis is complex and multifactorial, including luminal factors, immune dysregulation and genetic predisposition (4,7) . The three determinants of the diagnosis are non-bloody diarrhea, normal endoscopic picture of the colon, and pathognomonic histological picture (7)(8)(9) , but several cases are undiagnosed as a hidden cause of CD, resulting in missed treatment opportunities (7) .…”

Microscopic Colitis and Rheumatoid Arthritis: What does this Duet Tell Us? Literature Review and Clinical Case

“…CC is more common in the colon, which is a common feature of many autoimmune diseases. About 40% of MC cases are accompanied by other autoimmune diseases such as thyroiditis, type 1 diabetes mellitus, celiac disease, and RA, systemic sclerosis or CREST syndrome [31,32,37,40]. Although some studies show an increase in serum IgM, ANA, p-ANCA concentrations, there is no clinically useful marker for the diagnosis of MC yet [38,39].…”