Microscopic colitis

Classification according to ICD-10
K52.8	Other specified non-infectious gastroenteritis and colitis
ICD-10 online (WHO version 2019)

The microscopic colitis , or microscopic colitis is a chronic presumably, something atypical running inflammation of the mucosa of the colon , the cause of which is still not resolved before and clinically aqueous with severe diarrhea (diarrhea) accompanied. It does not lead to any macroscopically noticeable (i.e. endoscopically visible) changes in the mucous membrane and can therefore only be detected histologically, i.e. with the microscope . According to the histological picture, lymphocytic and collagenous colitis are distinguished as forms.

In both forms, a significant increase in lymphocytes can be observed in the surface epithelium of the intestinal mucosa. The peculiarity of collagenous colitis lies in the excessive formation of a membrane (physiologically present in every human being, but only a few micrometers thick), which normally separates the mucosal epithelial cells from the underlying layers of the intestinal wall. This membrane thickens in collagenous colitis and then essentially consists of repair collagens , such as those that occur in scarring . The genesis of the diarrhea is still not clear, but this thickened membrane is likely to play a role. It was first described in 1976 by Lindström .

causes

There are two basic theses about the origin of the disorder: One says that an autoimmune process is in the foreground, i.e. the body turns against itself for an unknown cause (partly also genetic) and the body's own cells wrongly interpreted as foreign cells and therefore fought (other examples : various thyroid diseases, diseases of the rheumatic type and, last but not least, also the classic chronic inflammatory bowel diseases ( IBD ) such as Crohn's disease and ulcerative colitis ). The result of the fight is the said inflammatory reaction. The second thesis is based on an as yet undiscovered bacterium or virus that leads to the said inflammatory reaction in the context of a chronic infection. There is also supposed to be a connection to celiac disease , but this has not been proven.

The consensus is now more in the direction of the first variant, i.e. autoimmune events. Hardly anyone believes in bacterial / viral genesis any more, even if it cannot be ruled out with certainty that there is a temporary intestinal infection at the beginning of the reaction chain, which then leads to chronic inflammation through sometimes autoimmunological processes. In this respect, it can most likely be assumed that the event is multifactorial.

therapy

Therapeutically, a concept has emerged that essentially corresponds to the procedure for Crohn's disease: a combination therapy of cortisone and 5-aminosalicylic acid (classic: budesonide or prednisolone and mesalazine ). The basic idea is to break through the inflammatory reaction with a short-term high dose and then keep it in check with maintenance therapy, whereby the regimen must be tailored to the individual case. Agents approved in Germany are budesonide and mesalazine . The use of TNF-alpha antibodies (infliximab, adalimumab) can achieve impressive therapeutic success in individual cases, but is not approved for therapy.

Diet measures are generally useless unless the patient finds out that he can tolerate certain things less well than others. Other forms of therapy have also proven to be ineffective over the past 25 years. As a symptomatic therapy for diarrhea, apart from the administration of loperamide and activated charcoal, there is not much that can be done that makes sense, but experience shows that the diarrhea improves as the inflammation recedes.

If the diagnosis is actually confirmed by taking multiple samples as part of one or, better still, several colonoscopies and the patient's well-being is clearly impaired by the diarrhea, anti-inflammatory treatment should be initiated if necessary. Once the diagnosis has been made, a gastroenterologist should consider which procedure is best on an individual basis.

literature

• Christof Rehbein: Immunohistochemical studies on the pathology of collagens and lymphocytic colitis . Dissertation (Faculty for Clinical Medicine Mannheim of the University of Heidelberg 1994)

Individual evidence

1. ↑ Gerd Herold and colleagues: Internal Medicine 2020. Self-published, Cologne 2020, ISBN 978-3-9814660-9-6 , p. 485.

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