Microscopic colitis and arthritis and a note on questran

[Guest guest]

Interesting article I ran across. This sounds a lot more like what I had

than the diagnosis of IBS I received back when I had this problem. Note

that cholysteramine (questran) is one treatment mentioned. Liz G.

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http://www.malinowski.com/faq.htm

Microscopic/Collagenous Colitis FAQ

Microscopic colitis (MC) is a name used to describe a chronic diarrheal

syndrome that is caused by inflammation in the colon/large intestine (i.e.,

colitis). It is called " microscopic " colitis because the inflammation can be

detected only with a microscope. During an endoscope procedure (colonoscopy

or sigmoidoscopy), the colon looks normal. The presence or absence of a

specific feature within the colonic inflammatory process as seen under the

microscope (thickened collagen under the surface of the biopsy) has led to

use of two other names for this syndrome: collagenous colitis and

lymphocytic colitis.

The authors of scientific journal articles differ in their opinions about

which name to use (microscopic, collagenous, or lymphocytic). Yet, the

symptoms and treatment of this syndrome are virtually identical, regardless

of whether the collagen in the biopsy is thick or normal. Thus, the name

microscopic colitis can be used to include both collagenous and lymphocytic

colitis. In this FAQ, microscopic colitis is used to refer synonymously to

either collagenous or lymphocytic colitis.

Diagnosis is made based upon microscopic analysis of biopsies of the colon.

The " typical " patient is a middle-aged woman; but it is seen in men,

children as young as seven and older people also. Possible initial

misdiagnoses include stress, gastroenteritis, celiac sprue, lupus, or

irritable bowel syndrome (IBS). It's not unusual for diagnosis to take

several years, since microscopic colitis is the form of inflammatory bowel

disease least familiar to doctors and therefore often the last considered.

Patients sometimes seek treatment for an elusive form of arthritis as much

as ten years prior to problems with diarrhea. This atypical arthritis can

affect the back, hips and sometimes ribs. It can come and go, and can change

locations. Other associated problems may include: iritis, purpura, thyroid

diseases, pernicious anemia, idiopathic pulmonary fibrosis, fibromyalgia,

unexplained severe itching, mouth sores, fatigue, depression, mitral valve

prolapse and celiac sprue (also called celiac disease). There does not seem

to be an association with Crohn's disease, ulcerative colitis, or cancer.

Most patients diagnosed with microscopic colitis are Caucasians living in

Northern Europe, Canada, the United States, Australia and New Zealand. It

does not appear to be contagious. Some patients report a close family member

with the same diagnosis or with similar intestinal symptoms, and it appears

there may be a hereditary tendency to get microscopic colitis.

The major symptom of microscopic colitis is watery diarrhea that may be

severe and sometimes even explosive. Necessary visits to the bathroom may

number up to 30 times a day. In rare cases, the diarrhea may be severe

enough to cause dehydration. Other symptoms may include weakness, difficulty

eating, abdominal bloating, and nausea. The diarrhea may come in sudden

bouts, giving only seconds of warning. There does not seem to be a

consistent dietary factor contributing to diarrheal episodes. Certain foods,

especially high fiber, fat, milk products, spices, wheat and/or uncooked

fruit and vegetables, may aggravate it. On the contrary, some patients

tolerate any foods -- even when quite ill. Many have difficulty eating

wheat, oats, bran and rye because they induce abdominal symptoms and

diarrhea. This fact, as well as other scientific evidence, indicates that

there may be clinical overlap of microscopic colitis with a disease called

celiac sprue. Celiac sprue is caused by an immunologic reaction of the

intestine to wheat, barley, rye, and oats.

Approximately half of the patients with microscopic colitis report a sudden

onset. They can pin down the exact day and location that symptoms started,

often triggered by an initial bout with dysentery, giardia, or an

undiagnosed intestinal illness.

One theory is that the inflammatory response is caused by a bacterium or a

bacterial toxin. Another theory suggests this is an autoimmune disease,

although that hasn't been conclusively established. A third suggests that

non-steroidal anti-inflammatory drugs (NSAIDs, such as aspirin or ibuprofen)

might be responsible or aggravate the symptoms in individuals predisposed to

the disease by another mechanism. It may well turn out to be a combination

of several of these factors.

TREATMENT:

Useful information has been sparse. This illness can come and go, with or

without treatment, making it difficult to assess the effect of any treatment

plan. Traditionally, treatment is started with sulfasalazine. Patients may

improve with sulfasalazine, but they are not necessarily cured. For the many

that don't tolerate sulfasalazine, Asacol (one brand of mesalamine or

5-aminosalicylic acid) is typically prescribed. These medicines are thought

to act as anti-inflammatory agents in the intestine.

Anti-diarrheal medications such as Imodium and Lomotil are used for

temporary relief, but tend to merely delay the diarrhea.

Studies done with prednisone (a corticosteroid) do not sound very promising

for long-term use. Most patients do respond quickly to this agent, so it can

be useful to stop a severe attack. However, the diarrhea routinely returns

when prednisone is discontinued. Long-term use of prednisone is discouraged

because the side effects (formation of cataracts, bone degeneration, high

blood pressure, and a tendency toward diabetes) can eventually be worse than

the benefits.

Some people report excellent short-term results with certain antibiotics;

however, the results generally are not long lasting.

A cholesterol-lowering drug called cholestyramine is helpful to some. Fiber

in the form of psyllium hydrophilic mucilloid (like Metamucil) also helps

some patients, but not others. Low dose tricyclic antidepressants (such as

Doxepin or Elavil) can sometimes help with the joint and muscle pain.

Surgical removal of the colon with formation of an ileostomy is a radical

approach and is seldom used.

Dr. Fine at Baylor Medical Center in Dallas, Texas is the leading

researcher investigating microscopic colitis. In a recent study, he

determined that a high dose (8 or 9 chewable tablets per day) of

Pepto-Bismol for 8 weeks can be quite effective. Preliminary results of a

second study, which is testing the effect of Pepto-Bismol against a placebo,

appear to verify this. Long-term outcomes are still under study.

Dr. Fine maintains an excellent web site for this disease. Since his

research moves at a fast pace, check his web site for current information:

http://www.bhcs.com/bumc/intestinalresearch/

Current research indicates that many patients who experience an early

relapse after PB treatment may be gluten intolerant, even if they appear to

test negative for celiac disease with prevailing tests. In those cases, a

gluten-free diet must be followed for life, but offers dramatic improvement

in many cases.

Since those with MC are genetically susceptible to recurrence, some MCers

are currently using an over-the-counter product called Culturelle.

Culturelle encourages the growth of healthy bacteria, which may help ward

off the growth of other bacteria that may trigger MC episodes. The pills do

not require refrigeration, and therefore can be easily used while traveling.

Dannon yogurt also provides live lactobacillus that, while a different type,

may be similarly beneficial.

Patients would do well to do their own research and attempt to remain

knowledgeable and current, as few doctors know much about microscopic

colitis. Although microscopic colitis is not progressive or fatal, it can be

disabling. Thus, it is important that patients learn how to cope with the

difficult social, physical and sometimes financial problems brought on by a

disease that can change their lifestyle enormously.

If you have been diagnosed with microscopic colitis, collagenous colitis, or

lymphocytic colitis, or have an interest in it, you may obtain free copies

of the collagenous colitis/microscopic colitis (CC/MC) newsletter, written

by and for those with this disease. More than 1200 of us are now taking part

in this unusual online forum.

The newsletter is available only by e-mail. Its purpose is to share support

and information. To read them on-line, browse to www.malinowski.com/cc.htm.

For more information, visit the CC Club Microscopic Colitis web site at

http://www.malinowski.com/colitis.htm.

For more information on Gluten Intolerance, visit that site at

http://www.malinowski.com/glutenfree.htm.

To request the newsletters, contact judy@... .

Updated October 6, 1999

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