Microscopic Colitis with Case

by Kelley Chuang, MD

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    00:00 Let's move to our next case now.

    00:03 A 65-year-old woman presents complaining of 5 months of watery diarrhea.

    00:08 She has 5-6 watery bowel movements a day with a few episodes at night.

    00:13 She has no weight loss, bloody stool, fevers or abdominal pain.

    00:17 Her only medication is amlodipine which she takes for hypertension.

    00:21 On exam, she has normal vitals, an unremarkable abdomen and her rectal exam is normal.

    00:28 Colonoscopy shows a normal colon.

    00:30 And biopsies of the colon are taken that show many lymphocytes infiltrating the lamina propria.

    00:38 What is the most likely diagnosis? So we'll point out that she has 5 months, so that's chronic diarrhea.

    00:46 She does have episodes of diarrhea at night which is a clue that suggests a secretory diarrhea.

    00:52 And she has importantly no alarm symptoms In addition, the gross appearance of the colon on colonoscopy is normal.

    01:03 The next thing we can look at is the lymphocytes infiltrating the lamina propria on a random biopsy for colon Putting this together, the gross appearance which is normal with lymphocyte infiltration on a random biopsy should hint at a diagnosis of microscopic colitis.

    01:22 So, her biopsy results are consistent with the diagnosis of lymphocytic colitis We'll talk about that in more detail next.

    01:30 So, lymphocytic colitis is a type of microscopic colitis.

    01:36 This is a chronic inflammation of the colon.

    01:39 Patients tend to present with chronic watery non-bloody diarrhea It tends to affect mostly middle-aged women.

    01:48 And as with our case, they often have a normal appearance on colonoscopy.

    01:54 However, on biopsy, you will find two subtypes, either lymphocytic colitis or collagenous colitis The diagnosis is made purely by the biopsy.

    02:05 And these patients are treated with antidiarrheals and corticosteroids Thank you very much for your attention.

    About the Lecture

    The lecture Microscopic Colitis with Case by Kelley Chuang, MD is from the course Approach to Patients with GI Symptoms.

    Included Quiz Questions

    1. Corticosteroids
    2. Infliximab
    3. Methotrexate
    4. Azathioprine
    5. Laxatives

    Author of lecture Microscopic Colitis with Case

     Kelley Chuang, MD

    Kelley Chuang, MD

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