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- Microscopic colitis (MC) is a relatively common cause of chronic, recurrent nonbloody diarrhea and has two subtypes: collagenous and lymphocytic colitis (LC). It is typically associated with autoimmune diseases and/or certain medications. Diagnosis requires a colonic biopsy with histologic tissue analysis.
- No significant difference in management of collagenous versus LC
- Up to 20–30% of chronic diarrhea is thought to be secondary to MC.
- Since 1985, the incidence in the United States has increased from 1 to 20 per 100,000 person-years.
- Prevalence ~103/100,000 persons
- More common in older individuals. The average age at diagnosis is 53 to 69 years.
- Female > male; ranging between 3:1 and 9:1
Etiology and Pathophysiology
- Unclear etiology; strong association with autoimmune diseases, smoking, and certain medications
- Models of pathogenesis include autoimmune destruction, inflammatory response to luminal factors, and myofibroblast dysfunction (for collagenous colitis [CC]).
- Animal models indicate bacterial translocation may play a role by inducing an inflammatory cascade in colonic mucosa which leads to increased mucosal permeability, increased cytokine release, degradation of collagen matrix, and dysregulation of subepithelial myofibroblasts.
No specific genetic mutation has been identified, but increased prevalence of human leukocyte antigen DR3 DQ2 allele noted in patients with MC.
- Nonsteroidal anti-inflammatory drugs
- Proton pump inhibitors
- Judicious use of associated medications
- Smoking cessation