About microscopic colitis collagenous type
What is microscopic colitis collagenous type?
Collagenous colitis is a rare digestive disorder that primarily affects females and typically becomes apparent during middle age. The disorder is characterized by inflammatory changes of the mucous membranes (mucosa) of the colon (colitis) and abnormal accumulation (excessive deposition) of the protein collagen beneath the surface (epithelial) layer of the mucosa (thickened subepithelial collagenous bands). The colon is the major portion of the large intestine. The medical literature often refers to collagenous colitis as a form of "microscopic colitis," since evidence of inflammation and other abnormalities may only be confirmed through microscopic (i.e., histologic) examination of multiple tissue samples.
Individuals with collagenous colitis typically experience episodes of chronic, watery, nonbloody diarrhea. In some instances, episodes may often occur at night (nocturnal diarrhea). Diarrheal episodes may be persistent or may occur at intervals (intermittent) over a period of weeks, months, or years. Other symptoms and findings that may occasionally be associated with such episodes include vague abdominal pain, abdominal swelling (distension), nausea, vomiting, and/or weight loss.
The exact cause of collagenous colitis is unknown. Possible immunological, environmental, genetic, and/or other factors are under investigation as potential causes of the disorder.
What are the symptoms for microscopic colitis collagenous type?
The symptoms of collagenous colitis can come and go, and vary in severity.
The most common symptoms include:
- chronic watery Diarrhea, which can appear and disappear over a period of weeks, months, or years
- Abdominal pain
- Abdominal cramps
Less common symptoms include:
- Weight loss
- flatulence or gas
- an urgent need to go to the bathroom
- fecal incontinence
What are the causes for microscopic colitis collagenous type?
Like many other gastrointestinal conditions, the exact cause of collagenous colitis is unknown. Research indicates that it likely has a genetic basis and could be related to autoimmune conditions.
Some possible causes of collagenous colitis include:
- genetic abnormalities
- autoimmune conditions such as rheumatoid arthritis, psoriasis, and Crohn’s disease
- certain bacteria or viruses
Collagenous colitis isn’t contagious. It can’t spread to other people.
Medications as triggers
Medications that may trigger microscopic colitis and collagenous colitis include:
- nonsteroidal anti-inflammatory drugs (NSAIDs)
- selective serotonin reuptake inhibitors (SSRIs), the most commonly prescribed class of antidepressants
- angiotensin-converting enzyme (ACE) inhibitors for high blood pressure
- angiotensin II receptor blockers (ARBs) for high blood pressure, heart disease, or kidney disease
Research is mixed on the effects of the following medications:
- statins for high cholesterol
- protein pump inhibitors (PPIs) and H2 receptor blockers, which are used to treat acid reflux and GERD
- oral medications for diabetes
Some research states that they have little to no effect on microscopic colitis, or may even be associated with lower rates of the condition.
Other studies indicate that these medications also trigger microscopic colitis and collagenous colitis.
According to a 2021 study, if these medications are associated with increased rates of microscopic colitis and collagenous colitis, it may be because they make diarrhea worse. A worsening case of diarrhea then prompts a doctor to make a diagnosis of colitis.
What are the treatments for microscopic colitis collagenous type?
In some cases, collagenous colitis disappears on its own. However, some people need treatment.
Your treatment plan will depend on the severity of your symptoms.
Diet and lifestyle changes
Your doctor may recommend diet and lifestyle changes to help treat this condition. These changes are usually the first part of any treatment plan.
Common diet changes include:
- eating a reduced fat diet
- opting for a gluten-free diet
- drinking more fluids to prevent dehydration from diarrhea
- switching to a milk-free diet
- avoiding food with artificial sweeteners
- eliminating caffeine and lactose
Common lifestyle changes include:
- quitting smoking, if you smoke
- maintaining a moderate weight
- maintaining a healthy blood pressure
- exercising regularly
Your doctor will review the medications you currently take and make suggestions about either continuing or stopping them.
In 2016, the American Gastroenterological Association (AGA) released its guidelines on microscopic colitis. The AGA recommends starting with budesonide, a type of corticosteroid, before considering other medications.
Other medications your doctor may recommend to help treat the symptoms of collagenous colitis include:
- antidiarrheal medications
- intestinal anti-inflammatory medications, such as mesalamine (Apriso, Asacaol HD, Pentasa) or sulfasalazine (Azulfidine)
- medications that block bile acids, such as cholestyramine (Prevalite)
The supplement psyllium may be recommended, too. Immunomodulators or anti-TNF (tumor necrosis factor) therapies may be used in extreme cases.
The Food and Drug Administration (FDA) hasn’t approved any medications for microscopic colitis or collagenous colitis. However, medications such as mesalamine and sulfasalazine are FDA approved for the treatment of ulcerative colitis.
If a doctor prescribes medications such as these for collagenous colitis, it’s considered an example of off-label drug use.
OFF-LABEL DRUG USE
Off-label drug use means a drug that’s approved by the FDA for one purpose is used for a different purpose that hasn’t yet been approved.
However, a doctor can still use the drug for that purpose. This is because the FDA regulates the testing and approval of drugs, but not how doctors use drugs to treat their patients. So your doctor can prescribe a drug however they think is best for your care.
Your doctor may recommend surgery if diet and medication changes don’t help. Surgery is usually reserved for extreme cases. It’s not a typical treatment for collagenous colitis.
The most common types of surgery for collagenous colitis include:
- colectomy, which means removing all or part of the colon
- ileostomy, which means creating an opening in the abdomen after a colectomy
What are the risk factors for microscopic colitis collagenous type?
Risk factors for microscopic colitis include:
- Age. Microscopic colitis is most common in people ages 50 to 70.
- Sex. Women are more likely to have microscopic colitis than are men. Some studies suggest an association between post-menopausal hormone therapy and microscopic colitis.
- Autoimmune disease. People with microscopic colitis sometimes also have an autoimmune disorder, such as celiac disease, thyroid disease, rheumatoid arthritis, type 1 diabetes or psoriasis.
- Genetic link. Research suggests that there may be a connection between microscopic colitis and a family history of irritable bowel syndrome.
- Smoking. Recent research studies have shown an association between tobacco smoking and microscopic colitis, especially in people ages 16 to 44.
Some research studies indicate that using certain medications may increase your risk of microscopic colitis. But not all studies agree.
Medications that may be linked to the condition include:
- Pain relievers, such as aspirin, ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve)
- Proton pump inhibitors including lansoprazole (Prevacid), esomeprazole (Nexium), pantoprazole (Protonix), rabeprazole (Aciphex), omeprazole (Prilosec) and dexlansoprazole (Dexilant)
- Selective serotonin reuptake inhibitors (SSRIs) such as sertraline (Zoloft)
- Acarbose (Precose)
- Carbamazepine (Carbatrol, Tegretol)
- Clozapine (Clozaril, Fazaclo)
- Entacapone (Comtan)
- Paroxetine (Paxil, Pexeva)
- Simvastatin (Zocor)
Is there a cure/medications for microscopic colitis collagenous type?
Collagenous colitis typically responds well to therapy. Sometimes the symptoms may even go away on their own without treatment. Doctors will initially advise a patient to cease using any medications that have been linked to collagenous colitis.
There are numerous drugs that can be used to lessen or eliminate symptoms. The majority of research indicates that the first line of treatment for collagenous colitis should be budesonide.
The following additional popular prescription drugs are used to treat collagenous colitis:
- Supplements that increase the bulk of stools, such as psyllium (Metamucil), antidiarrheal drugs, typically those containing bismuth subsalicylate, diphenoxylate, or loperamide, alternative statins, such as cholestyramine liadla (mesalamine), and antibiotics.
- Immunomodulatory or anti-tumor necrosis factor therapy, which obstructs a portion of the immune response, may be prescribed by doctors if symptoms do not get better.
- Usually, changing one's lifestyle can also aid in symptom reduction. These consist of giving up smoking, maintaining healthy body weight, blood pressure, and hydration while engaging in regular exercise and refraining from abusing over-the-counter NSAIDs like aspirin and ibuprofen.
- In a small percentage of situations, a doctor may advise surgery to treat collagenous colitis when severe symptoms do not improve with other forms of treatment.