"Irritable bowel syndrome" could be microscopic colitis

Luise Heine has been an editor at since 2012. The qualified biologist studied in Regensburg and Brisbane (Australia) and gained experience as a journalist in television, in the Ratgeber-Verlag and in a print magazine. In addition to her work at , she also writes for children, for example for the Stuttgarter Kinderzeitung, and has her own breakfast blog, “Kuchen zum Frühstück”.

More posts by Luise Heine All content is checked by medical journalists.

Again and again for no apparent reason abdominal pain and watery diarrhea - many think of the so-called irritable bowel syndrome. But a little-known bowel inflammation has very similar symptoms.

Many people in this country suffer from irritable bowel syndrome. But it is often a diagnosis of embarrassment: You simply cannot find any other explanation for the recurring abdominal discomfort. It could also be a largely unknown intestinal inflammation - microscopic colitis. "We assume that this bowel disease is the cause of chronic diarrhea in ten percent of women over 50," says Prof. Ahmed Madisch from Hanover.

This means that microscopic colitis is just as common as chronic intestinal inflammation (IBD), Crohn's disease or ulcerative colitis. Why is it so rarely diagnosed? It is probably due to their unspecific symptoms: bulging pain, nausea and watery diarrhea.

Visible only under the microscope

To make matters worse, microscopic colitis, as the name suggests, can only be clearly identified under the microscope. Certainly one of the reasons why the disease was first described in 1976. But this also means: "If this disease is suspected, tissue samples must be taken from the intestinal mucosa," says gastroenterologist Madisch. This is usually done as part of a colonoscopy.

Under high magnification, the pathologists look for a conspicuous accumulation of lymphocytes - a certain subspecies of white blood cells. They are responsible for the immune defense in the intestine. If you find small clusters of these cells scattered all over the place, the diagnosis is pretty clear: lymphocytic colitis. The changes in the intestinal mucosa, on the other hand, are invisible to the naked eye.

The second sub-form of microscopic colitis is the collagen form, which is revealed to the trained eye under the microscope through a thickened layer of connective tissue-like material (collagen) under the mucous membrane cells in the intestine.

Reason unknown

The exact mechanism by which the disease develops is still unknown. However, researchers have various risk factors in their sights. Apparently smokers are affected much more often than non-smokers - they are 14 years more likely to fall ill on average. It is also assumed that medication, bile acid, but also the intestinal flora influence colitis. Age also plays a role: While the diagnosis of IBD patients is usually between 15 and 35 years, the mean age of onset for microscopic colitis is between 50 and 60 years. Women are affected much more frequently than men; four out of five patients are female. People with microscopic colitis suffer considerably. "The quality of life is enormously restricted," says intestinal expert Madisch.

Colitis: Budesonide as a therapy option

Some are lucky and the disease goes away as suddenly as it came. Most patients, however, struggle with recurring episodes. Then only medication can help.

In Germany, only one substance is currently approved for treatment: budesonide, a cortisone preparation. It is also used for numerous other inflammatory diseases such as asthma, hay fever or rheumatism. The symptoms of four out of five patients can be contained with the corticosteroid. Unfortunately, mostly not permanently, which is why scientists are still looking for a treatment concept to keep microscopic colitis in check in the long term. Such concepts also exist with Crohn's disease and ulcerative colitis.

Compared to these IBDs, microscopic colitis has at least one advantage: the risk of colon cancer is not increased for those affected.

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