Beyond the Endoscope: Unmasking the Hidden Cause of Chronic Watery Diarrhoea in a Middle-Aged Lady-from IBS-D to Microscopic Colitis

Abstract

Microscopic colitis is a chronic inflammatory disease of the colon that is characterized by chronic, watery, non-bloody diarrhea. It typically occurs in middle-aged patients and has a female preponderance. The colon appears typically normal or almost normal on colonoscopy in patients with microscopic colitis. The diagnosis is established by biopsy of the colonic mucosa demonstrating characteristic histologic changes. Microscopic colitis has two main histologic subtypes, lymphocytic colitis, more specifically defined in 1989, and collagenous colitis. It is treatable, but in the developing world, its diagnosis may often prove difficult. Data and reports of this condition in Bangladesh are scarce because most medical centers lack a functional gastrointestinal endoscopy unit that would aid in the diagnosis. We here in present a case of a 55-year-old lady who was getting treatment for refractory Irritable Bowel Syndrome-Diarrhea (IBS-D). Eventually she was diagnosed with lymphocytic microscopic Colitis. She started treatment with steroid, cholestyramine, later with azathioprine and improved dramatically.