The clinical profile of adult Sri Lankans having microscopic colitis not otherwise specified (NOS) admitted to a medical unit of a tertiary care hospital

Abstract

Objective: To study the clinical profile of adult Sri Lankans having microscopic colitis not otherwise specified (NOS) admitted to a medical unit of a tertiary care hospital.

Method: Case notes of 83 consecutive patients admitted to Sri Jayawardenepura General Hospital, histologically diagnosed as having microscopic colitis from January 2008 to January 2012 were retrospectively analyzed.

Results: Age range was 21-84 years, mean age 51.1+/- 17.4 SD years. Sex distribution male: female 48:35 (1.3:1). Presentation had been a watery diarrhea, abdominal pain, weight loss, asthenia and bleeding per rectum in 55.4%, 42.2%, 40.9%, 38.1% and 2.4% of the instances respectively. 71.1% had no major associated background problems. Hypertension, diabetes mellitus, bronchial asthma was present in 21.7%, 8.0% and 7.2% of the instances respectively.

The salient histological feature was infiltration of plasmacytes and lymphocytes beyond lamina propria without other specific features of colitides. Rectum, sigmoid, transverse colon, ascending colon, descending colon, ceacum were histologically involved in 89.2%, 86.7%, 68.7%, 65.1%, 60.2%, 38.1% of the instances respectively. Pancolitis was seen in 25.3%.

Inflammatory markers (ESR and/or C-RP) were elevated in 20.8% where they have been done. Neutrophilia was noted in 13.3%. Non steroidal anti inflammatory drugs and proton pump inhibitors have been prescribed in 6.0% and 4.8% instances respectively where information was available.

Conclusions: Microscopic colitis not specified otherwise seem to be an ill defined colitis which could represent low grade immunological reaction to an unidentified intra-luminal antigen causing therapeutic dilemmas. Further studies are needed for better categorization and to define the outcome.