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MICROSCOPIC COLITIS

Microscopic colitis is an inflammation in the large intestine which causes watery stools. It is a type of inflammatory bowel disease. The colon tissue is examined under the microscope and therefore the name microscopic colitis. The colon tissue is examined under the microscope as in other diagnostic tests it may appear like normal tissues. Microscopic colitis is a painful condition but not as severe as inflammatory bowel diseases.

Microcopic colitis consists of two types of diseases such as collagenous colitis and lymphocytic colitis. Collagenous colitis is a thick layer of protein called the collagen that is formed on the colon tissue. Lymphocytic colitis is a condition in which the white blood cells or the lymphocytes increase in the tissues of the large intestine. These two conditions are the different phases of the same condition. Both the types of colitis affect the tissues of the colon.

SIGNS AND SYMPTOMS

The signs and symptoms of microscopic colitis include:

  • Weight loss
  • Watery diarrhea
  • Nausea
  • Vomiting
  • Pain in the abdomen
  • Abdominal cramps
  • Bloating
  • Dehydration
  • Fecal incontinence

People suffering from chronic watery diarrhea which lasts for more than a week should immediately consult a doctor for proper treatment. The symptoms may come and go. For most of the people the symptoms may disappear even before the treatment.

CAUSES

The cause of inflammation in the colon due to microscopic colitis is not clear, however a few causes of microscopic colitis are:

  • Bacteria may be one of the main causes of inflammation in the colon as it may produce toxins that irritate the colon lining or the wall of the colon.
  • Mediations may also cause irritation in the lining of the colon.
  • Autoimmune diseases such as rheumatoid arthritis, celiac disease etc which are associated to microscopic colitis may also cause inflammation in the colon.
  • Viruses also play a major role in causing swelling or inflammation in the colon.

RISK FACTORS

The following risk factors of microscopic colitis are:

  • People between the ages 50 and 70 years are at a risk of developing microscopic colitis. This condition is more common among women than men.
  • People with microscopic colitis usually also suffer from autoimmune diseases such as celiac disease, thyroid disease etc.
  • People with a family history of the disease may also be at a risk of developing this condition.
  • Smokers may also be at a risk of developing microscopic colitis.

DIAGNOSIS

The following are the tests performed to diagnose microscopic colitis.

  • Physical examination is the first thing the doctor performs. The doctor may also ask for the complete medical history of the patient.
  • Blood test is performed to check the levels of white blood cells as an increase in the level of white blood cells may indicate the presence of infection.
  • Ultrasound and CT scan are performed in a patient suffering from microscopic colitis to get a clear view of the images of the colon.
  • Colonoscopy is a test performed which uses a camera and a lighted tube that allows the doctor to look directly inside the colon, and stomach. A colonoscopy test is performed for a better evaluation of the condition, to check for the presence of polyps, inflamed tissues, ulcers etc.

TREATMENT

Microscopic colitis may go away on its own without any treatment. If the condition persists, the doctor may suggest these steps.

  • Avoid having food and drinks that increase or worsen the symptoms such as fatty food, dairy products, caffeine etc.
  • Have food which is rich in fiber or take fiber supplements.
  • Take the medications prescribed by the doctor.
  • The doctor may prescribe over the-counter medicines such as Imodium and Pepto-Bismol to treat the condition.
  • The doctor may also prescribe a few drugs which may help in reducing inflammation. The drugs include Asacol, Colazal, Azulfidine or steroids which are useful in bringing down swelling in people suffering from microscopic colitis.
  • If these medicines do not work and the condition remains the same, the patient may have to undergo a surgery to treat microscopic colitis.

PREVENTION

The preventive measures for microscopic colitis are:

  • Eat more fibrous food
  • Drink plenty of fluids
  • Exercise regularly
  • Eat small meals rather than large meals

POEM

Peroral endoscopic myotomy or POEM is an endoscopic procedure performed to treat swallowing disorders such as achalasia and esophageal spasms. It is a newly developed invasive technique that takes nearly one to three hours to complete. The main advantage of this technique is that there are no incisions in the chest or abdomen and requires a minimum hospital stay. Very few countries are offering this less-invasive approach to treat swallowing disorders.

About Achalasia

Achalasia is a condition in which lower esophageal sphincter (a valve which allows food to pass from the esophagus into the stomach) fails to open up during swallowing, resulting in back up of food within the esophagus. This is mainly caused by damage to the esophageal nerves. People with achalasia often experience trouble while swallowing food which may lead to coughing, choking, and burning in the chest etc. There is no cure for achalasia, however, the symptoms can be managed with various treatment options such as medications, balloon dilatation, botulinum toxin injection. However, these are considered as less invasive techniques when compared to POEM due to low efficacy and high complication rates.

PROCEDURE OF POEM

Apart from achalasia, POEM is indicated for other conditions like diffuse esophageal spasms (a condition characterized by uncoordinated contractions of the esophagus) and jackhammer esophagus (intense esophageal spasms). PEOM is the only treatment option when other surgical techniques failed to manage the conditions.

Before the surgery

To prepare for the surgery, the patient should follow certain instructions like:

  • Having only liquid diet for 2 days prior to the procedure
  • The patient should not eat or drink anything for at least 12 hours before the surgery to keep the esophagus and stomach clear
  • The patient should inform the doctor regarding other health conditions or about the medications they take
  • The patient will have to undergo few examinations on the day of surgery

During the surgery

After taking to the operating room, the patient will be given anesthesia and antibiotics intravenously. POEM is performed under general anesthesia and hence the patient will be asleep throughout the procedure.

An endoscope which is a long, thin tube is inserted into the esophagus through the mouth. A small camera attached to the end of the tube helps the doctor to monitor and control the endoscope.

Using a specific knife placed at the end of the endoscopic tube, the doctor makes incision in the internal lining of the esophagus to permit entry to the wall of the esophagus where muscle is exposed. Then the inner layer of the muscle near the lower esophageal sphincter will be cut to loosen the tight esophageal muscles that are responsible for the swallowing problems. This is called myotomy. The muscles on sides of the esophagus, the lower esophageal sphincter and the upper part of the stomach are cut and loosened. After this step, the esophageal incision will be closed with standard endoscopic clips that are inserted at the lining of the esophagus. The endoscopic tube is then removed through the mouth.

This procedure relieves the tightness of the esophageal muscles and allows the food to pass into the stomach normally.

Recovery

The patient should stay in the hospital for one night to check if there any complications related to the surgery. The patient will not be allowed to eat or drink anything for the day following the surgery. The next day, barium test will be performed to check if the esophagus muscle is open and there is no leakage. If the patient passes the test, liquid diet will be given.

Intravenous antibiotics will be discontinued three days after the procedure; they should be taken orally for another 7 days. The evaluation tests like manometry, pH metry, and endoscopy are repeated for every 3 to 6 months to check the efficacy, complications, and side effects (if any) of the procedure.

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