In the two main types of irritable bowel disease (Crohn’s and Ulcerative Colitis) the damage to the gut lining is on such a scale that it can be seen when a colonoscopy or an endoscopy is carried out. These large-scale changes are macroscopic, however as the name suggests, the damage found in Microscopic colitis is small, microscopic.
Microscoptic colitis is most commonly seen in women over the age of 60. While it may not be associated with a reduction in life expectancy but as with other digestive issues quality of life can be drastically reduced. Chronic watery diarrhoea is the most common symptom and occurs in 7.5% of this group. It is not uncommon to experience up to 15 bowel movements a day. Other symptoms include bloating and pain, nausea, fatigue and weight loss.
You’re more likely to develop Microscopic colitis is you have a history / family history of autoimmunity, particularly coeliac disease. Habitual smoking and regular use of a range of medication which include NSAIDs, PPIs (ie omeprazole), beta blockers, or statins are also risks. Changes in the bacteria in the gut also seem to play a role especially. It’s been seen that beneficial anti-inflammatory species of bacteria are reduced and levels of pro-inflammatory bacteria increase. This can preceed the onset of symptoms.
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Microscopic Colitis Testing
Complete stool testing is vital to assess and infections such as cryptosporidium, and giardia. C. difficile toxins, salmonella and shigella are also important to assess for. Stool testing also provides information of how well you are (or may not be) producing digestive enzymes which can also impact gut function. Evaluation of thyroid health and coeliac disease are also helpful as are complete blood counts.
Ruling out SIBO (small intestinal bacteria overgrowth) can also be helpful in certain cases. This is to assess the bacterial load in the small bowel as elevated numbers here can also contribute to chronic diarrhea.
A note about testing
I aim to keep testing as affordable as possible. While some of these tests may be requested via your GP others can only be ordered through private laboratories. Part of the initial consultation is set aside to discuss the pro, cons and costs associated with the various tests I feel would be the most helpful.
A number of diets are recommended which are suggested on a case by case basis. The aim of these is to assess for food sensitivities, assess triggers and well as to reduce inflammation.