Living with the Disease and
Controlling its Symptoms
and Support Forum for Microscopic Colitis
Potty Humor to Help
Relieve the Stress
Doctor Who Understands the Disease
MC with mast
What is gluten?
How can I find out if I
am sensitive to gluten?
Before starting on a
Should I try a GF diet or
an elimination diet?
The elimination diet
Foods that contain gluten
Foods that contain dairy
Foods that contain soy
Foods that contain corn
Tips on starting the diet
delicious recipes free of
gluten, dairy, and soy
Stool tests (EnteroLab)
Blood tests (Mediator
about Lab Tests
Discussions about MRT
Typical EnteroLab Test
Results for Someone Who has MC
MRT Test Results
for Someone Who has MC
of the Very First Internet LISTSERV Dedicated to
When the site opens, click on the Newsletter Archive link,
then select any newsletter to read it)
From the Original microscopiccolitis.org Website
Medication Guide — Index
The only surviving
discussions from Sally's original board can be found at the links
From Aug. 3, 2004
From Oct. 30, 2004
From Dec. 5, 2006
From Dec. 14, 2006
From Apr. 4, 2007
From Apr. 18, 2007
From Oct. 9, 2007
Colitis: The Elephant in the Room That No One Seems to Notice
Unless They Have It
colitis (MC) may be the Rodney Dangerfield of the
inflammatory bowel diseases (IBDs) — it gets no respect. At
least it gets precious little respect from the medical
profession, and virtually
none from any of the big nonprofit national and
international IBD support organizations.
Gastroenterology specialists seem to view it as a benign
disease with a self-limiting outcome.
The "Big Three", Crohn's disease, ulcerative colitis,
and celiac disease, get almost all the publicity, and
therefore all but a small percentage of the
official support and research money, while MC continues to be viewed as
a back burner issue by doctors, researchers, and many of the most
prestigious IBD support organizations. Of
course, the big IBD support organizations don't even recognize celiac
disease as an IBD, so it's not surprising that they would tend to
ignore MC. Celiac disease has its own research and support
network, and that implies that MC must do likewise if it is to ever
gain wide recognition, since support for MC from existing IBD support
organizations does not appear to be forthcoming.
association of coeliac disease and microscopic colitis: A large
Disease: On the Rise
compared with the other IBDs, MC is a relative latecomer to the
game. The first type of MC, collagenous colitis (CC), wasn't
described until 1976. Lymphocytic colits (LC) wasn't
described until 1980, and it was initially called microscopic colitis,
but the name was changed to lymphocytic colitis in 1989.
Still, being late to the game does not make it any less
worthy of support.
of attention is certainly not due to an insufficient number of MC
cases, because a Canadian
study that was published in 2011 showed that microscopic colitis is
actually significantly more common than both Crohn’s disease and
ulcerative colitis.1 The same study
also showed that
the incidence of MC is more than 60 % higher than celiac
disease. So if MC is more common than all of the other IBDs,
then why is it so often ignored, or treated as the proverbial
red-headed step child in most medical circles?
this lack of respect and attention will
eventually have to come to an end, because according to the Canadian
study, the incidence of MC is increasing at an average annual
growth rate of 12 %. If one computes the growth rate of
disease, based on a recent study done by the Mayo clinic, that showed
that celiac disease is 4 times as common as it was 50 years ago, then
disease apparently has an annual growth rate of approximately 7%.2 Clearly, MC
is increasing almost twice as fast as celiac disease. At some
point, it will surely become obvious to all concerned that MC is the
elephant in the room, and those organizations and individuals who seem
to have their head in the sand
will be forced to acknowledge it's prominence.
are at least a dozen different types of microscopic colitis that have
been described to date, and more will probably be discovered in the
future. On this site, we will refer to all variations of the
disease as simply microscopic colitis, except in instances where the
specific attributes of individual types needs to be considered.
Why do they resolve microscopic
colitis symptoms for some
patients, but trigger the same symptoms for others?
specialists have been prescribing antidepressants to treat MC since
they first discovered that one of the listed side effects of this class
of drugs is constipation. Of course, as is the case with most
prescription drugs, no one understands exactly how they actually work
anyway, but certain characteristics are known.
of the more popular (and more recently-developed) antidepressants are
classified as selective serotonin reuptake inhibitors, (SSRIs), and
some of the even-newer drugs are classified as serotonin-norepinephrine
reuptake inhibitors, (SNRIs). And there are various
types of antidepressants that modify the availability or utilization of
certain mood-controlling neurotransmitters, hormones, and
neuropeptides. In this
discussion, I'd like to focus on the
characteristic ability of SSRIs and SNRIs to enhance the availability
of serotonin. Roughly 90% of the body's supply of serotonin
located in the digestive tract, especially in the intestines, and
serotonin is known to help regulate intestinal motility.
link to an article with a lot of background information about this
The Other Brain Also
Deals With Many Woes - NYTimes.com
the serotonin in insect and plant venom that causes pain from an insect
sting, or a jab from a plant spine. Pathogenic amoebas
serotonin, which causes diarrhea if the intestines are infected.
So we know that an increase of serotonin levels
diarrhea for many people, and as a result, it's no wonder that the
SSRIs and SNRIs are well
known for triggering the development of MC for many people,
especially after relatively long-term use. For many of those
individuals, however, relief from diarrhea is within easy reach —
just discontinuing the use of the drug will typically bring
unfortunately, additional intervention is required before remission can
be attained, especially if the problem is not addressed for
In section II of the book Microscopic
a theory is developed (and supported with citations from many published
research reports) to demonstrate that chronic stress appears to be the
primary cause of IBDs and other autoimmune diseases. Stress
promotes intestinal inflammation by causing an increase in the
degranulation of mast cells, and so mast cells release
histamines, cytokines, and
various other inflammatory mediators. If this is the case,
it would be logical to assume that reducing stress levels would be
helpful for preventing the development of MC and other IBDs.
indeed, for some people who have MC, antidepressants can bring
remission from the symptoms of the disease.
It's difficult to
say exactly what happens in those
cases, because medical science has
never figured out all the details of how these drugs work.
While drugs in this class do have an indirect effect on the
suppression of the development of inflammation due to
inappropriate mast cell degranulation (by reducing stress), there's no
scientific evidence that this mode of action is the main reason why
some MC patients respond favorably to certain antidepressants.
is known, for example, that corticosteroids appear to reduce
inflammation by suppressing the number of mast cells. But in
few cases, antidepressants have been shown to bring remission when
corticosteroids failed to provide relief. That suggests that
cell degranulation may not be the primary problem in that particular
With microscopic colitis, motility is typically disrupted, and
in the majority of cases, rapid transit is a characteristic feature.
In a certain subset of patients, though, reduced motility can
a problem, and this issue primarily affects the stomach.
Gastroparesis (delayed emptying of the stomach) is typically
associated with diabetes, but it can also be involved with MC.
Gastroparesis can result in a feeling of fullness, nausea,
headaches, vertigo, and sometimes other symptoms, as food rots in the
stomach because it is not allowed to pass into the small intestine
where the digestive process can be continued.
For patients in
this group, it appears that the increased serotonin levels generated by
the use of an SSRI or SNRI may help to correct the reduced motility
problem caused by gastroparesis, resulting in the restoration of a more
normal motility pattern that aids in resolving the symptoms of MC.
In addition, as a secondary benefit, the increased serotonin
level in the blood (and therefore also in the brain) should help to
counteract the effects of stress both in the central nervous system and
in the enteric nervous system.
Please note that these drugs will
only benefit a certain group of patients who have MC — for others, they
can make the symptoms worse. In my opinion, I would rate
treatment option as the number four option in the hierarchy of
treatment choices for controlling the symptoms of MC. The
1. Diet changes
Budesonide (arguably the safest corticosteroid that can be used to
treat MC, and the most effective type of prescription medication
available to safely treat the disease)
If none of those
treatments bring relief after a reasonable length of time, (or if a
combination of any of them fail to bring remission), then an
antidepressant might be worth a try. Note that these
are based on the treatment experiences of many hundreds of people who
have microscopic colitis, and who have shared their experiences on the discussion
and support board listed under Important
Links on this page, but this has
not been verified by scientific research.
Cells and How They Affect
Microscopic Colitis, Celiac Disease, and Other IBDs
are mast cells?
are mast cells associated with microscopic colitis?
do I know if mast cells are causing problems for me?
are mast cell issues treated?
Research that may Lead to Future Treatment Options
following articles are based on information in the above book
and the tight junctions
vaccine for gluten sensitivity
Interleukin-15 and vitamin A
Phloretin may be more effective than mesalamine