Expert: DANIL HAMMOUDI.MD - 8/16/2004

Question
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Followup To
Dr. Hammoudi,
Thank you so much for your speedy and very thorough response.  I feel I understand things a little better.  I am hoping for the best.  Do gastroenterologists generally test further to see if there is any underlying cause such as an autoimmune component (celiac, thyroid, etc.)?
Thank you again.
Chris
Question -
Dr. Hammoudi,
Thank you so much for your time.  I hope you can help.  I am a 36yr.female.  I was recently in the hospital due to complications from sinus surgery.  I had hemorrhaging and required emergency surgery and transfusion.  
The day after my surgery I began having diarrhea, which over the next few days got progressively worse and more uncomfortable.  I was going to the bathroom about 20-25 times a day, and it was completely watery.  I had blood on and off as well. I never felt any relief after going to the bathroom. The cramping was awful.  They did a test for c-diff. which came out negative.  Then a gastroenterologist came in to see me.  During the physical exam he said my bowel sounds were so hyper, he couldn't hear my breath sounds.  He also said my colon felt spongy.   With my symptoms and the fact that I had been on mulitple antibiotics for an extended period of time, he felt it was c-diff. despite the negative result.I was put on flagyl and  I was then scheduled for a colonoscopy.
After the colonoscopy I was told that visually they could see something called microscopic colitis.  Now it has been three weeks after the diarrhea first started.  I remained in the hospital for 2 weeks, not just because of the colitis.  I am now taking asacol, I was removed from the flagyl. I lost 13lbs. and I am already thin. The diarhea is less frequent, but on and off it gets very bad.  It still remains watery, and I continue with cramping and discomfort. I also am very achy and have no energy whatsoever.
My questions:
Could you explain a little about microscopic colitis?
How long will it take to go away?
Will I have to remain on medications?
Does achiness go along with this problem?
Do they do follow-up colonoscopies to see if it has improved?
Any information you have on this disease would be very helpful.  I thank you so much again for your time.
Chris
Answer -
Hard to say as if these colitis were there already before the surgery.
But overall considering that everything was normal before surgery all what happened can be caused by the following:
stress ulceration from the surgery and its complication
infection including c difficil
antibiotics intake
and blood swallowed at the begining giving some other bacteria to grow faster as helicobacter or other.Microscopic colitis including collagenous colitis, lymphocytic colitis and I think in your case was more lymphocytic [white cells involvement cause by various infection or stress hard to make the difference, but I believe in your case and I can be mistaken that stress started then infection and antibiotics took over as overall in these condition cause of these conditions is unknown. Possibilities include unidentified chronic gastrointestinal infections, immune disturbance (including autoimmune disease), and medications (e. g. some non-steroidal antiinflammatory agents, ranitidine, carbemazepine).
]
Patients with these disorders present with chronic diarrhoea. Abdominal pain, fatigue, and weight loss are also common. A number of associated diseases may occur, including connective tissue disorders, thyroid diseases, and coeliac disease. The diagnosis requires that other disorders be ruled out (e.g. ulcerative colitis, Crohn's disease, gastrointestinal infections).

so in your case specifically I think that these ulceration will heal with time, it might take one to two months may be less may be more hard to predict, but your symptoms seenms to get better with time which is a good pronostic, and I suggest a colonoscopy in three months to see where you are at in the healing process.I cannot tell if you will still under treatment or not hard for me to say but I think not since you are getting better
there is no proven treatment a number of medications will help. These include bismuth subcitrate, mesalazine, cholestyramine, and corticosteroids [do not suggest ]. Some patients will get better without any treatment. Rarely, patients will require a diverting ileostomy because of intractable diarrhea.
For your aching mostly due to bilirirubin malabsorption should get better as well unless there is another cause of it.

Hope this answers your question
Thanks
dan  

Answer
usually yes but at the first 3 months it is beside basic treatment a watch and see since it can be caused by stress and other after 3 months if it does not healed than further investigation are needed as biopsie to see another cause as autoimmune.
thanks