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This website is dedicated to the OTHER Inflammatory Bowel Diseases — Microscopic Colitis, Collagenous Colitis, Lymphocytic Colitis, Mastocytic Enterocolitis, and Other Forms of the Disease

What is microscopic colitis?
What microscopic colitis is not
Treatment methods found to be most effective

Living with the Disease and Controlling its Symptoms

Discussion and Support Forum for Microscopic Colitis

Success Stories

Potty Humor to Help Relieve the Stress

Find a Doctor Who Understands the Disease

Conventional microscopic colitis

MC with mast cell issues

Dealing with Food Sensitivities

What is gluten?

How can I find out if I am sensitive to gluten?

Before starting on a gluten-free diet

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

Combined list

Tips on starting the diet

Hundreds of delicious recipes free of
gluten, dairy, and soy

Lab Tests for Food Sensitivities

Stool tests (EnteroLab)

Blood tests (Mediator Release Testing)

Discussions about Lab Tests

Discussions about EnteroLab Testing

Discussions about MRT Testing

Typical EnteroLab Test Results for Someone Who has MC

Typical MRT Test Results for Someone Who has MC

Historical Information

Archives of the Very First Internet LISTSERV Dedicated to Microscopic Colitis

(Note:  When the site opens, click on the Newsletter Archive link, then select any newsletter to read it)

Information From the Original Website

Sally's Story

Sally's Medication Guide — Index

The only surviving archived discussions from Sally's original board can be found at the links listed below:

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

 Microscopic Colitis:  The Elephant in the Room That No One Seems to Notice Unless They Have It

Microscopic  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.

True, 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.

This lack 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?

Obviously, 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 celiac 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 celiac 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.

There 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.

1. The association of coeliac disease and microscopic colitis: A large population-based study.

2. Celiac Disease: On the Rise

Insights and Ponderings

Antidepressants:  Why do they resolve microscopic colitis symptoms for some patients, but trigger the same symptoms for others?

GI 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.

Many 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 other 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 is located in the digestive tract, especially in the intestines, and serotonin is known to help regulate intestinal motility.  Here's a link to an article with a lot of background information about this process.

The Other Brain Also Deals With Many Woes -

It's the serotonin in insect and plant venom that causes pain from an insect sting, or a jab from a plant spine.  Pathogenic amoebas produce serotonin, which causes diarrhea if the intestines are infected.  So we know that an increase of serotonin levels tends to cause 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 remission.  For others, unfortunately, additional intervention is required before remission can be attained, especially if the problem is not addressed for months or years.

In section II of the book Microscopic Colitis, 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, then it would be logical to assume that reducing stress levels would be helpful for preventing the development of MC and other IBDs.  And 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.  It is known, for example, that corticosteroids appear to reduce inflammation by suppressing the number of mast cells.  But in a few cases, antidepressants have been shown to bring remission when corticosteroids failed to provide relief.  That suggests that mast cell degranulation may not be the primary problem in that particular group of patients.

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 be 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 this treatment option as the number four option in the hierarchy of treatment choices for controlling the symptoms of MC.  The other options are:

1. Diet changes
2. An antihistamine
3. 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 observations 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.

Mast Cells and How They Affect Microscopic Colitis, Celiac Disease, and Other IBDs

What are mast cells?

How are mast cells associated with microscopic colitis?

How do I know if mast cells are causing problems for me?

How are mast cell issues treated?

Current Research that may Lead to Future Treatment Options

The following articles are based on information in the above book

Zonulin and the tight junctions

A vaccine for gluten sensitivity

A gluten digestion inhibitor

Interleukin-15 and vitamin A

Phloretin may be more effective than mesalamine

Previous Articles

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