Stomach Trouble? Understanding Microscopic Colitis

Microscopic colitis (MC) is an inflammatory condition defined by chronic watery diarrhea, abdominal pain, and fatigue. Crucially, the inflammation is only visible under a microscope, meaning the colon looks totally normal during a colonoscopy. Definitive diagnosis requires a three-step process: symptoms, normal colonoscopy, and multiple biopsies (to account for patchy inflammation). The two subtypes are Collagenous Colitis (thick collagen band seen) and Lymphocytic Colitis (extra white blood cells seen). MC is more common in women, usually diagnosed around age 61, and risk is significantly increased by smoking. There is a strong link to other autoimmune disorders (40% of patients have another) and to common medications (NSAIDs, PPIs, SSRIs). The primary, highly effective treatment is the targeted corticosteroid Budesonide, which achieves remission in 68% of patients. MC is a benign chronic condition that does not increase the risk of colorectal cancer, and surgery is almost never needed.