Frequently Asked Questions
What is the difference between Collageneous Colitis (CC), Lymphocytic Colitis (LC), Ulcerative Colitis (UC) and IBS or IBD?
Collageneous colitis (CC) is marked by thickened collagen deposits in the epithelium of the colon, several times thicker than normal. Lymphocytic colitis (LC) is marked by lymphocytic infiltration in the epithelial surface of the colonic mucosa, although CC may also show lymphocytes, LC does not involve thickened collagen layers. Both forms of the disease are commonly referred to as Microscopic Colitis (MC).
With the other inflammatory bowel diseases (IBDs) such as Crohn's disease and Ulcerative colitis (UC), lesions (sores) in the mucosal lining of the colon are commonly visible to the naked eye, and blood may be present in the stool. While Crohn's disease can affect any part of the gastrointestinal system, from mouth to anus, UC usually begins at the rectum and spreads backward through the colon. By contrast, even though the clinical symptoms of MC may seem as debilitating as the other IBDs, it does not cause bleeding, and when a GI specialist examines the mucosal lining of the colon through a colonoscope, it typically appears normal on the monitor screen.
IBS stands for “Irritable Bowel Syndrome”, and it is not an IBD. In fact, it could be argued that IBS is not actually a disease at all, because there are no specific diagnostic criteria for "IBS". IBS is simply a default diagnosis when known digestive system diseases are ruled out. The reality is, in most cases IBS may simply be undiagnosed celiac disease, or one of the other IBDs, a symptom of food sensitivities, or an early (prediagnostic) stage of celiac disease or one of the other IBDs that does not yet meet the rigid criteria that would allow it to qualify for an official diagnosis. For many decades, "IBS" was the default diagnosis when a GI specialist failed to take biopsy samples during the colonoscopy exam of patients who actually had MC.
What causes MC?
None of the suspected causes of MC have ever actually been proven by means of rigid scientific methods to cause the disease, but many conditions seem to be associated with the development of the disease. Many medical professionals believe that IBDs (including MC) are caused by an autoimmune issue when the body’s immune system attacks either the gut bacteria or the body’s own intestinal tissue. Some suspect that a yet-to-be-discovered pathogen might be the cause, either in the form of a bacterium or a virus.
The records show that many cases of MC have developed following infections with various parasites or bacteria, such as C. difficile, E. coli, or one of the other common intestinal pathogens, and the risk of developing the disease apparently increases whenever some type of infection reoccurs or becomes especially severe. Since viruses have the ability to alter genes and they are known to have epigenetic attributes, some authorities feel that a virus may be involved in the development of MC.
There is evidence that microscopic colitis can be triggered not only by pathogens, but by chemical compounds, medications, and even the cleanout solutions used to prepare for a colonoscopy examination. Terminating a long-term smoking habit has triggered many cases of the disease. In fact, it appears that just about any digestive system issue that can lead to enteritis (intestinal inflammation) can result in the development of microscopic colitis.
Some of the medications thought to trigger MC include most antibiotics, non-steroidal anti-inflammatory drugs (NSAIDS), proton pump inhibitors (PPIs), selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), beta-blockers, statins, and bisphosphonates. Obviously not everyone who uses these drugs will develop the disease, so apparently genetics and environmental effects influence the way these medications may or may not affect us.
It is apparent to those who have the disease that stress can make the symptoms of the disease worse, but to date no medical research has explored this, and so stress has not been shown by specific medical research to be a proven cause of the disease. However, there is a substantial body of scientific research, that when compiled and properly aggregated, appears to offer compelling evidence that stress may not only be implicated as one of the possible triggers in the disease, but it may actually be a primary cause of microscopic colitis. There is a significant amount of empirical evidence indicating that such a link may be possible, based on the observation that many cases of MC develop in individuals who have been exposed to extended periods of extreme stress.
What foods besides gluten can cause problems or aggravate my MC?
During an acute flare of MC, many foods can aggravate MC. Sources of fiber and sugar, such as raw vegetables, fruit, beans, nuts, and seeds tend to irritate the intestines, and these foods can prevent the gut from healing. The primary food-based problem in most cases however, is sources of protein that cause our immune system to produce antibodies which then go on to trigger other immune system events that result in the classic T-cell inflammation that is characteristic of LC and is also usually present with CC. The most common offenders are gluten (found in wheat, rye, and barley), casein (found in all dairy products), soy, and eggs. For some of us, other foods such as other grains, beef, pork, and in some cases, chicken, and possibly other foods can trigger a reaction.
Is MC contagious?
No, however, some authorities have noted that there are case studies where multiple family members have developed the disease, suggesting either a familial risk, or a common environmental trigger for the disease.
Can the SCD (Special Carbohydrate Diet) work for MC like it works for Ulcerative Colitis?
Yes. The SCD is more restrictive than the gluten-free diet, since it eliminates ALL grains and lactose-containing dairy products. However, since most of us are also sensitive to the casein in all dairy products, we find that we typically have to avoid all dairy products, including the ones permitted by the SCD. When all dairy products are removed from the SCD, this basically results in a paleo diet. For this reason, most of us find the paleo diet to be more useful than the SCD for treating MC.
Is it possible to become pregnant if I have MC?
Yes, it is possible to become pregnant after an MC diagnosis! Many medications are safe for use during pregnancy, as long as they are reviewed and approved by your physician. And of course treatment by diet changes is perfectly safe during pregnancy as long as you and your doctors work together to make sure that you do not have any vitamin deficiencies.
One of the enigmas associated with MC is the fact that in some cases pregnancy may bring remission, whereas in other cases it can cause an MC flare. Apparently this is due to the influence of hormonal changes that occur during pregnancy, but little research has been done on this topic, so the details remain a mystery. As with any medical issue, it is important to stay in contact with your doctor while pregnant.
How is MC diagnosed?
Biopsy samples taken from the mucosal lining of the colon during a colonoscopy or sigmoidoscopy exam are examined under a microscope by a pathologist. The presence of a significantly increased number of lymphocytes or thickened collagen bands are diagnostic of LC or CC respectively.
I have been diagnosed with MC, do I need a second opinion?
No, not if the diagnosis was made by a qualified pathologist who examined biopsy specimens of your colon under the microscope. A diagnosis of MC is sometimes overlooked, if a pathologist fails to notice certain markers, but MC is virtually never diagnosed where it does not exist.
Is MC fatal or chronic? Can it be cured?
MC is generally classified as a benign (non-fatal) disease. However that does not mean that it cannot be debilitating, and one's quality of life is often seriously affected. Dehydration commonly occurs as a result of the diarrhea associated with the disease, and dehydration can have serious or even fatal consequences if it is not properly treated. The disease is typically chronic (as are all IBDs), meaning that treatment (either by diet changes or by the use of medications, or by a combination) must be maintained at all times, if the diseases is to be keep in stable remission. As with all IBDs, there is no known cure for MC, however the symptoms can certainly be controlled by proper treatment. Spontaneous remission of MC symptoms sometimes occurs in certain cases, but this does not seem to be common.
Can MC lead to other diseases or additional health problems such as cancer, autoimmune issues or skin disorders?
MC patients typically have an increased risk of developing additional autoimmune (AI) diseases or skin disorders, however no increased risk of cancer is known to be associated with the disease. It should be noted that after the inflammation that causes MC has been controlled, and remission has been maintained for a few years, the increased risk of developing additional AI issues typically declines so that the risk is no greater than anyone else in the general population. It's inflammation that causes the development of AI diseases, so controlling MC symptoms is very important for long-term health.
A skin condition called “Dermatitis Herpetiformis” (DH) can occur in those who have gluten sensitivity. The characteristic rash looks like tiny blisters, can be quite itchy, and often occurs on the hands but can occur in other areas as well. DH can take a very long time to resolve, but as with the other symptoms of MC, DH can be controlled by careful attention to diet.
How common is MC?
For decades MC was thought to be a rare disease. Because of that glitch in their training, gastroenterologists rarely looked for it, and consequently they rarely found it. But as they began to more routinely take biopsies during colonoscopy and sigmoidoscopy exams, they began to find many more cases. In fact, more recent research shows that MC is at least as common as Crohn's disease, and much more common than celiac disease. So it is actually rather common.
How can I get immediate relief from my symptoms?
While obtaining immediate relief might be wishful thinking for most of us, following a very restrictive diet such as a BRAT diet (Bananas, Rice, Applesauce and Tea) will sometimes bring significant improvement within a few days in some cases. Most of us find that it takes longer, so it tends to be more practical to follow an elimination diet that avoids the most common food sensitivities while providing enough protein and other nutrients to allow our intestines to heal (in anticipation of a longer recovery period).
What are the symptoms and severity of MC?
The symptoms can vary in type and severity. Most common are explosive diarrhea 10-20 (or more) times per day, fatigue, joint pain, stomach pain or discomfort, gas and bloating, among others. The severity varies from person to person. Rather than diarrhea, some patients experience constipation, and nausea and vomiting are common for some of us.
What medications are generally taken for MC symptoms?
Commonly prescribed medications include anti-inflammatory medications based on mesalamine as the active ingredient, such as Asacol, Colazal, Pentasa, Apriso, Lialda, etc., corticosteroids based on budesonide , such as Entocort, or Uceris (these corticosteroids have limited immunosuppressant effects), and Prednisone (a corticosteroid that can have significant immunosuppressant effects).
For symptomatic relief, safe analgesics include Tylenol (acetaminophen) for mild pain relief, and Ultram for moderate to severe pain. Some of the topically-applied analgesics have also been found to be safe for MC patients. Medications such as Lomotil or Imodium (antidiarrheals) can be used to slow down motility and reduce the urgency of needing to locate a bathroom. Medications such as Levsin (anti-spasmotic) or Questran (cholestyramine) sometimes help to reduce the diarrhea.
Are there any medications found to increase the symptoms of MC?
NSAIDS such as aspirin, Advil, Ibuprofen, and Naproxen are notorious for triggering MC reactions. Many antibiotics can also trigger an MC flare, or make an existing flare worse. Proton pump inhibitors (PPIs) are well known for causing MC reactions. As noted in the section on What causes MC?, above, other medications known to be associated with the development of MC, and that can make an existing flare worse, include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), beta-blockers, statins, and bisphosphonates. In cases where PPIs have been prescribed, H2 blockers may be a better (safer) choice for anyone who has MC. Examples of H2 blockers include Zantac, Pepcid, Tagamet, and Axid.
Should I take Vitamins/Supplements?
While a few people who have MC feel that probiotics are helpful, most patients find that during recovery, most probiotics either make no noticeable difference, or make the symptoms much worse. In general, probiotics are better tolerated after a patient has been in stable remission for a while. MC tends to cause a malabsorption problem, and because of that issue most nutrients and many vitamins and minerals may not be absorbed as well as they would normally be.
Because a vitamin D deficiency increases the odds of developing an IBD, and IBDs tend to deplete vitamin D reserves, most people who have MC need additional vitamin D in order to boost immune system robustness. That means that someone who has MC typically uses more vitamin D than someone in the general population, and therefore they probably need additional vitamin D supplementation. The immune system cannot work properly without an adequate supply of vitamin D, so this makes vitamin D a relatively important vitamin, especially for someone who has an IBD.
When someone has been experiencing a flare for a relatively long period of time (such as years), certain other vitamins, such vitamin B-12, and possibly some of the other B vitamins, may become deficient. Many MC patients are also short of magnesium, but since magnesium can act as a laxative, supplementation must be done carefully. Some forms of magnesium supplement such as chelated magnesium (magnesium glycinate) are far less likely to cause diarrhea than some of the other forms. Topically-applied magnesium is much safer than orally-administered magnesium, because it can be absorbed through the skin without causing any laxative effects. The label of any supplements used should always be checked to make sure that the ingredient list does not include any ingredients derived from foods known to cause problems, particularly gluten, dairy, and soy.
How can I find out more about MC?
Join or read on the discussion and support board listed under Support, in order to learn how others have successfully controlled their MC symptoms. Or you can click on the link below.
Collageneous colitis (CC) is marked by thickened collagen deposits in the epithelium of the colon, several times thicker than normal. Lymphocytic colitis (LC) is marked by lymphocytic infiltration in the epithelial surface of the colonic mucosa, although CC may also show lymphocytes, LC does not involve thickened collagen layers. Both forms of the disease are commonly referred to as Microscopic Colitis (MC).
With the other inflammatory bowel diseases (IBDs) such as Crohn's disease and Ulcerative colitis (UC), lesions (sores) in the mucosal lining of the colon are commonly visible to the naked eye, and blood may be present in the stool. While Crohn's disease can affect any part of the gastrointestinal system, from mouth to anus, UC usually begins at the rectum and spreads backward through the colon. By contrast, even though the clinical symptoms of MC may seem as debilitating as the other IBDs, it does not cause bleeding, and when a GI specialist examines the mucosal lining of the colon through a colonoscope, it typically appears normal on the monitor screen.
IBS stands for “Irritable Bowel Syndrome”, and it is not an IBD. In fact, it could be argued that IBS is not actually a disease at all, because there are no specific diagnostic criteria for "IBS". IBS is simply a default diagnosis when known digestive system diseases are ruled out. The reality is, in most cases IBS may simply be undiagnosed celiac disease, or one of the other IBDs, a symptom of food sensitivities, or an early (prediagnostic) stage of celiac disease or one of the other IBDs that does not yet meet the rigid criteria that would allow it to qualify for an official diagnosis. For many decades, "IBS" was the default diagnosis when a GI specialist failed to take biopsy samples during the colonoscopy exam of patients who actually had MC.
What causes MC?
None of the suspected causes of MC have ever actually been proven by means of rigid scientific methods to cause the disease, but many conditions seem to be associated with the development of the disease. Many medical professionals believe that IBDs (including MC) are caused by an autoimmune issue when the body’s immune system attacks either the gut bacteria or the body’s own intestinal tissue. Some suspect that a yet-to-be-discovered pathogen might be the cause, either in the form of a bacterium or a virus.
The records show that many cases of MC have developed following infections with various parasites or bacteria, such as C. difficile, E. coli, or one of the other common intestinal pathogens, and the risk of developing the disease apparently increases whenever some type of infection reoccurs or becomes especially severe. Since viruses have the ability to alter genes and they are known to have epigenetic attributes, some authorities feel that a virus may be involved in the development of MC.
There is evidence that microscopic colitis can be triggered not only by pathogens, but by chemical compounds, medications, and even the cleanout solutions used to prepare for a colonoscopy examination. Terminating a long-term smoking habit has triggered many cases of the disease. In fact, it appears that just about any digestive system issue that can lead to enteritis (intestinal inflammation) can result in the development of microscopic colitis.
Some of the medications thought to trigger MC include most antibiotics, non-steroidal anti-inflammatory drugs (NSAIDS), proton pump inhibitors (PPIs), selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), beta-blockers, statins, and bisphosphonates. Obviously not everyone who uses these drugs will develop the disease, so apparently genetics and environmental effects influence the way these medications may or may not affect us.
It is apparent to those who have the disease that stress can make the symptoms of the disease worse, but to date no medical research has explored this, and so stress has not been shown by specific medical research to be a proven cause of the disease. However, there is a substantial body of scientific research, that when compiled and properly aggregated, appears to offer compelling evidence that stress may not only be implicated as one of the possible triggers in the disease, but it may actually be a primary cause of microscopic colitis. There is a significant amount of empirical evidence indicating that such a link may be possible, based on the observation that many cases of MC develop in individuals who have been exposed to extended periods of extreme stress.
What foods besides gluten can cause problems or aggravate my MC?
During an acute flare of MC, many foods can aggravate MC. Sources of fiber and sugar, such as raw vegetables, fruit, beans, nuts, and seeds tend to irritate the intestines, and these foods can prevent the gut from healing. The primary food-based problem in most cases however, is sources of protein that cause our immune system to produce antibodies which then go on to trigger other immune system events that result in the classic T-cell inflammation that is characteristic of LC and is also usually present with CC. The most common offenders are gluten (found in wheat, rye, and barley), casein (found in all dairy products), soy, and eggs. For some of us, other foods such as other grains, beef, pork, and in some cases, chicken, and possibly other foods can trigger a reaction.
Is MC contagious?
No, however, some authorities have noted that there are case studies where multiple family members have developed the disease, suggesting either a familial risk, or a common environmental trigger for the disease.
Can the SCD (Special Carbohydrate Diet) work for MC like it works for Ulcerative Colitis?
Yes. The SCD is more restrictive than the gluten-free diet, since it eliminates ALL grains and lactose-containing dairy products. However, since most of us are also sensitive to the casein in all dairy products, we find that we typically have to avoid all dairy products, including the ones permitted by the SCD. When all dairy products are removed from the SCD, this basically results in a paleo diet. For this reason, most of us find the paleo diet to be more useful than the SCD for treating MC.
Is it possible to become pregnant if I have MC?
Yes, it is possible to become pregnant after an MC diagnosis! Many medications are safe for use during pregnancy, as long as they are reviewed and approved by your physician. And of course treatment by diet changes is perfectly safe during pregnancy as long as you and your doctors work together to make sure that you do not have any vitamin deficiencies.
One of the enigmas associated with MC is the fact that in some cases pregnancy may bring remission, whereas in other cases it can cause an MC flare. Apparently this is due to the influence of hormonal changes that occur during pregnancy, but little research has been done on this topic, so the details remain a mystery. As with any medical issue, it is important to stay in contact with your doctor while pregnant.
How is MC diagnosed?
Biopsy samples taken from the mucosal lining of the colon during a colonoscopy or sigmoidoscopy exam are examined under a microscope by a pathologist. The presence of a significantly increased number of lymphocytes or thickened collagen bands are diagnostic of LC or CC respectively.
I have been diagnosed with MC, do I need a second opinion?
No, not if the diagnosis was made by a qualified pathologist who examined biopsy specimens of your colon under the microscope. A diagnosis of MC is sometimes overlooked, if a pathologist fails to notice certain markers, but MC is virtually never diagnosed where it does not exist.
Is MC fatal or chronic? Can it be cured?
MC is generally classified as a benign (non-fatal) disease. However that does not mean that it cannot be debilitating, and one's quality of life is often seriously affected. Dehydration commonly occurs as a result of the diarrhea associated with the disease, and dehydration can have serious or even fatal consequences if it is not properly treated. The disease is typically chronic (as are all IBDs), meaning that treatment (either by diet changes or by the use of medications, or by a combination) must be maintained at all times, if the diseases is to be keep in stable remission. As with all IBDs, there is no known cure for MC, however the symptoms can certainly be controlled by proper treatment. Spontaneous remission of MC symptoms sometimes occurs in certain cases, but this does not seem to be common.
Can MC lead to other diseases or additional health problems such as cancer, autoimmune issues or skin disorders?
MC patients typically have an increased risk of developing additional autoimmune (AI) diseases or skin disorders, however no increased risk of cancer is known to be associated with the disease. It should be noted that after the inflammation that causes MC has been controlled, and remission has been maintained for a few years, the increased risk of developing additional AI issues typically declines so that the risk is no greater than anyone else in the general population. It's inflammation that causes the development of AI diseases, so controlling MC symptoms is very important for long-term health.
A skin condition called “Dermatitis Herpetiformis” (DH) can occur in those who have gluten sensitivity. The characteristic rash looks like tiny blisters, can be quite itchy, and often occurs on the hands but can occur in other areas as well. DH can take a very long time to resolve, but as with the other symptoms of MC, DH can be controlled by careful attention to diet.
How common is MC?
For decades MC was thought to be a rare disease. Because of that glitch in their training, gastroenterologists rarely looked for it, and consequently they rarely found it. But as they began to more routinely take biopsies during colonoscopy and sigmoidoscopy exams, they began to find many more cases. In fact, more recent research shows that MC is at least as common as Crohn's disease, and much more common than celiac disease. So it is actually rather common.
How can I get immediate relief from my symptoms?
While obtaining immediate relief might be wishful thinking for most of us, following a very restrictive diet such as a BRAT diet (Bananas, Rice, Applesauce and Tea) will sometimes bring significant improvement within a few days in some cases. Most of us find that it takes longer, so it tends to be more practical to follow an elimination diet that avoids the most common food sensitivities while providing enough protein and other nutrients to allow our intestines to heal (in anticipation of a longer recovery period).
What are the symptoms and severity of MC?
The symptoms can vary in type and severity. Most common are explosive diarrhea 10-20 (or more) times per day, fatigue, joint pain, stomach pain or discomfort, gas and bloating, among others. The severity varies from person to person. Rather than diarrhea, some patients experience constipation, and nausea and vomiting are common for some of us.
What medications are generally taken for MC symptoms?
Commonly prescribed medications include anti-inflammatory medications based on mesalamine as the active ingredient, such as Asacol, Colazal, Pentasa, Apriso, Lialda, etc., corticosteroids based on budesonide , such as Entocort, or Uceris (these corticosteroids have limited immunosuppressant effects), and Prednisone (a corticosteroid that can have significant immunosuppressant effects).
For symptomatic relief, safe analgesics include Tylenol (acetaminophen) for mild pain relief, and Ultram for moderate to severe pain. Some of the topically-applied analgesics have also been found to be safe for MC patients. Medications such as Lomotil or Imodium (antidiarrheals) can be used to slow down motility and reduce the urgency of needing to locate a bathroom. Medications such as Levsin (anti-spasmotic) or Questran (cholestyramine) sometimes help to reduce the diarrhea.
Are there any medications found to increase the symptoms of MC?
NSAIDS such as aspirin, Advil, Ibuprofen, and Naproxen are notorious for triggering MC reactions. Many antibiotics can also trigger an MC flare, or make an existing flare worse. Proton pump inhibitors (PPIs) are well known for causing MC reactions. As noted in the section on What causes MC?, above, other medications known to be associated with the development of MC, and that can make an existing flare worse, include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), beta-blockers, statins, and bisphosphonates. In cases where PPIs have been prescribed, H2 blockers may be a better (safer) choice for anyone who has MC. Examples of H2 blockers include Zantac, Pepcid, Tagamet, and Axid.
Should I take Vitamins/Supplements?
While a few people who have MC feel that probiotics are helpful, most patients find that during recovery, most probiotics either make no noticeable difference, or make the symptoms much worse. In general, probiotics are better tolerated after a patient has been in stable remission for a while. MC tends to cause a malabsorption problem, and because of that issue most nutrients and many vitamins and minerals may not be absorbed as well as they would normally be.
Because a vitamin D deficiency increases the odds of developing an IBD, and IBDs tend to deplete vitamin D reserves, most people who have MC need additional vitamin D in order to boost immune system robustness. That means that someone who has MC typically uses more vitamin D than someone in the general population, and therefore they probably need additional vitamin D supplementation. The immune system cannot work properly without an adequate supply of vitamin D, so this makes vitamin D a relatively important vitamin, especially for someone who has an IBD.
When someone has been experiencing a flare for a relatively long period of time (such as years), certain other vitamins, such vitamin B-12, and possibly some of the other B vitamins, may become deficient. Many MC patients are also short of magnesium, but since magnesium can act as a laxative, supplementation must be done carefully. Some forms of magnesium supplement such as chelated magnesium (magnesium glycinate) are far less likely to cause diarrhea than some of the other forms. Topically-applied magnesium is much safer than orally-administered magnesium, because it can be absorbed through the skin without causing any laxative effects. The label of any supplements used should always be checked to make sure that the ingredient list does not include any ingredients derived from foods known to cause problems, particularly gluten, dairy, and soy.
How can I find out more about MC?
Join or read on the discussion and support board listed under Support, in order to learn how others have successfully controlled their MC symptoms. Or you can click on the link below.
