Microscopic colitis is a term encompassing collagenous and lymphocytic colitis. It denotes the absence of endoscopic (macroscopic) abnormalities in the presence of microscopic histopathology.

Collagenous and lymphocytic colitis are clinicopatho-logic syndromes that represent distinct, possibly autoimmune, forms of idiopathic inflammatory colonic bowel disease. Both disorders present as chronic, watery, noninfectious diarrhea in middle-aged patients with negative radiographic and endoscopic studies. Collagenous colitis predominantly occurs in women; lymphocytic colitis is found equally in both genders. Often there is intermittent, diffuse abdominal pain, and, not surprisingly, some patients have a previous diagnosis of irritable bowel syndrome (IBS). Routine blood studies generally show normal results, but elevations in the Westergren sedimentation rate and eosinophil count are not uncommon. Abnormalities in complement levels, serum immunoglobulins (Igs), and pANCA (antineutrophil cytoplasmic antibodies) may be found. Although stool studies are negative for pathogens and blood, up to 55% of patients have white blood cells in stool samples. Other medical conditions reported to occur concomitantly with collagenous and lymphocytic colitis include thyroid disease, inflammatory arthropathies, pernicious anemia, urethral fibrosis, vitiligo, and small bowel villous atrophy. This association is discussed in the chapter on celiac disease (Chapter 61, "Celiac Sprue and Related Problems").

Gastrointestinal (GI), radiographic, and endoscopic examinations are not diagnostic with collagenous colitis. By endoscopic examination, the colorectal mucosa is usually normal, although some nonspecific findings, such as erythema, paleness, and edema, have been reported in up to one-third of cases.

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