Your Good Health: Diagnosis of Microscopic Colitis Might Actually be Celiac Disease

Dr Keith Roach Defends Celiac DiseaseSyndicated medical columnist suggests that a diagnosis of microscopic colitis might be wrong.

  • Dr. Keith Roach, Your Good Health, 1

Dear Dr. Roach:I have had microscopic colitis since 2013 and have been prescribed 3 mg of Entocort every day. I have some good days but mostly not-so-good days.”

“Changing my diet does not seem to help, and I have been advised that this problem will continue for the rest of my life. I am now 77 years old and of average weight. I have a glass of wine periodically and do not smoke.”

“With different treatments now available, is there something that could be suggested for me? I have not been able to travel to see family since 2013 and am mostly housebound, as I cannot travel very far at all. Accidents happen, and that makes me more cautious of travel.”

Dr. Keith Roach: Microscopic colitis can refer to one of two types: lymphocytic colitis and collagenous colitis. As the “itis” in the name suggests, it is characterized by inflammation. The rest of the name lets you know the inflammation is in the colon.

Unlike Crohn’s disease — another type of inflammatory bowel condition — microscopic colitis does not have disease that’s visible with endoscopy. The main symptom of microscopic colitis is chronic, non-bloody, watery diarrhea, usually five to 10 times per day, but sometimes far more. Abdominal pain and weight loss often occur.

Budesonide (Entocort) is a powerful steroid anti-inflammatory that is not absorbed by the body, so it remains active all the way through the intestinal tract into the colon. It is often very effective, but if you are having more not-so-good days than good days, it is certainly time to consider alternatives.

The first thing to consider is whether the diagnosis might have been wrong. Early Crohn’s disease can look very much like microscopic colitis. Irritable bowel syndrome has a lot of overlap with microscopic colitis.

Celiac disease has often been mistaken for microscopic colitis. It might be time for another careful look, including biopsies and blood testing for celiac if you have not had that.

Hyperthyroidism, drug toxicity (especially anti-inflammatories like ibuprofen) and secretory tumours all can mimic microscopic colitis.

If it is microscopic colitis, cholestyramine is a very effective additional treatment for diarrhea in people with fairly mild, persistent symptoms. People with persistent severe symptoms may need more potent therapy, such as infliximab or 6-MP. An expert, preferably a gastroenterologist with special expertise in inflammatory bowel disease, is the ideal consultant for this condition.

  • Dr. Keith Roach graduated from the University of California, Berkeley, with a degree in molecular biology. He earned his M.D. at the University of Chicago, and did his internship and medicine residency training there. In 2000, Dr. Roach moved to New York, joining the faculty at Weill Cornell Medical College and New York Presbyterian Hospital as an Associate Attending Physician and Associate Professor of Clinical Medicine. He has won every major teaching award offered by that institution. He also served as program director for the primary care internal medicine training program.

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