| Abstract [eng] |
Rationale. Microscopic colitis is a common inflammatory bowel disease with overlapping symptoms with other large intestine diseases, significant diagnostic and management challenges. Aim. To describe the types of microscopic colitis and their diagnostic challenges through clinical case analysis and literature review. Methods. Data from five female patients with microscopic colitis was examined. Supported by a literature review, disease manifestation, course, diagnostics, and treatment were identified. Patient data on anamnesis, comorbidities, laboratory and imaging results were gathered from Vilnius University Hospital Santaros Klinikos following written informed consent. Results. Patient A: A 55-year-old presented with vomiting, watery diarrhea, and fever. In the absence of a response to symptomatic treatment and an elevated fecal calprotectin an imflammatory bowel disease was suspected and prompted colonoscopy which histologically confirmed lymphocytic colitis. Budesonide achieved disease control. Risk factors: reactive arthritis, hormone replacement therapy, long-term smoking. Patient B: A 51-year-old presented with bloody painful defecation after hemorrhoid surgery. As bloody stools persisted, a colonoscopy was performed, histologically revealing lymphocytic colitis, budesonide was effective. Risk factors: nonsteroidal anti-inflammatory drugs, antihypertensive medications. Patient C: A 55-year-old with celiac disease and Crohn's disease had received ineffective mesalazine for 20 years. Due to a histological picture consistent with remission of Crohn’s disease, a slightly elevated fecal calprotectin level and persistent diarrhea a colonoscopy was performed and histologically revealed incomplete lymphocytic colitis. Budesonide was initiated but switched to azathioprine due to lack of response. Risk factors: celiac disease, Crohn's disease, rheumatoid arthritis, smoking. Patient D: A 53-year-old with chronic watery diarrhea underwent colonoscopy confirming collagenous colitis. After mesalazine failure, prednisolone side effects and a definitive collagenous colitis diagnosis, budesonide was initiated. Risk factors: antidepressants, proton pump inhibitors, postcholecystectomy syndrome. Patient E: A 41-year-old presented with 11 years of watery diarrhea. Colonoscopy confirmed collagenous colitis, budesonide achieved control. Risk factor: family history of Crohn's disease. Conclusions. Pathogenetic risk factors associated with microscopic colitis include older age, female sex, genetic predisposition, autoimmune and inflammatory bowel diseases, intestinal infections, proton pump inhibitors, nonsteroidal anti-inflammatory drugs, hormone replacement therapy, antidepressants, and smoking. As symptoms are non-specific, diagnosis requires fecal calprotectin testing, endoscopy, and histological analysis. Budesonide is the first-line treatment. Microscopic colitis is a complex inflammatory bowel disease presenting with chronic watery diarrhea and histological heterogeneity, divided into lymphocytic and collagenous subtypes. Consistent monitoring and treatment are essential for disease control. |
