Microscopic Colitis: Who Is At Risk For Developing It?

When I was first diagnosed with Collagenous Colitis, one of the first questions that popped into my head was, “How on Earth did I get this?” I had never had any sort of a digestive issue. I was always clock regular on my trips to the bathroom, and I had a cast-iron stomach. So, I decided to do a little digging and find out what puts people at risk for developing Microscopic Colitis.

Science has not been able to definitively determine what actually causes Microscopic Colitis (MC). They have, however, found certain factors increase a person’s risk of developing it. These risk factors include gender, age, the presence of other autoimmune disorders, the use of certain medications, what region of the world you live in, and smoking tobacco products.

Women Are At Higher Risk

Women are up to 7x more likely to develop Microscopic Colitis than men

Women are far more likely to develop Microscopic Colitis than men are. Women are approximately 5 to 7 times more likely to develop collagenous colitis than men are, and approximately 2 to 5 times more likely to develop lymphocytic colitis. (Collagenous and lymphocytic colitis are the two main forms of Microscopic Colitis.) (1)

Women are, in fact, more likely to develop autoimmune disease in general. An autoimmune disease is when a person’s immune system attacks the body’s own cells and tissue. Scientist believe women might be at higher risk for autoimmune disease because they have lower levels testosterone than men do.

Scientists have known for a while that there is a link between testosterone and autoimmune disorders. Testosterone has been shown to reduce the number of B cells in a person’s body. B cells are a type of lymphocyte that releases harmful antibodies. But researchers were never sure WHY this was the case.

A recent study shows a connection between testosterone and the protein BAFF. This protein makes B cells more viable. The study shows that testosterone suppresses BAFF in the body, thus lowering the number of B cells. So, the study theorizes that lower testosterone levels in women may mean higher levels of BAFF, and therefore more B cells. More studies need to be done to confirm this however (2).

People Over 50

Even though people of any age, including children, can develop Microscopic Colitis, it is far more prevalent in people over the age of 50 than in any other age group.

Some believe it might be hormonal changes associated with age–combined with medications commonly taken by older people such as statins, PPIs, and anti inflammatory drugs–may explain why people over the age of 50 are more likely to develop Microscopic Colitis.

However, some scientists are beginning to question if age actually is a risk factor. Someone under the age of 50 who presents with chronic diarrhea is less likely to be given a colonoscopy than an older patient, and colonoscopy or sigmoidoscopy with biopsies are the only way to definitively diagnose Microscopic Colitis. So, it’s possible that the incidences of Microscopic Colitis in younger people is more prevalent than believed and has been misdiagnosed as Irritable Bowel Syndrome (IBS) because of testing procedures. (1)

Having Other Autoimmune Disorders

Another risk factor doctors look at when diagnosing Microscopic Colitis is if the patient has another autoimmune disorder. There is a high correlation between people having other autoimmune diseases such as Hashimoto’s, rheumatoid arthritis, and celiac disease also having microscopic colitis.

One theory behind this correlation is having an autoimmune disorder triggers the release of lymphocytes (white blood cells that are one of the body’s main types of immune cells), which damage the lining of the colon. This leads to the development of Microscopic Colitis.

However, scientist are not sure if the presence of Microscopic Colitis in patients with other autoimmune disorders is an effect of those autoimmune disorders or a cause of them.

The Use Of Certain Medications

There has been a link between the use of certain medications and Microscopic Colitis. This is one of the primary factors considered by doctors when determining if a patient might have microscopic colitis vs IBS or another IBD.

Long-term regular use of these medications is most commonly associated with Microscopic Colitis:

nonsteroidal anti-inflammatory drugs such as aspirin, ibuprofen, and naproxen
lansoprazole (Prevacid)
acarbose (Prandase, Precose)
ranitidine (Tritec, Zantac)
sertraline (Zoloft)
ticlopidine (Ticlid)

Other medications that have been linked to Microscopic Colitis include:

carbamazepine
clozapine (Clozaril, FazaClo)
dexlansoprazole (Kapidex, Dexilant)
entacapone (Comtan)
esomeprazole (Nexium)
flutamide (Eulexin)
lisinopril (Prinivil, Zestril)
omeprazole (Prilosec)
pantoprazole (Protonix)
paroxetine (Paxil, Pexeva)
rabeprazole (AcipHex)
simvastatin (Zocor)
vinorelbine (Navelbine) (3)

Researchers aren’t sure if these medications are causing the onset of Microscopic Colitis, or if they are exasperatingly an already existent condition and making symptoms more noticeable.

Location, Location, Location

Northern countries receive less direct sunlight, especially in winter. This can affect vitamin D levels.

One interesting connection is where you live might put you at higher risk for Microscopic Colitis. People in northern climates are more likely to develop Microscopic Colitis than people living closer to the equator. This has led some scientists to theorize that lower levels of vitamin D, the main source of which is exposure to the Sun, might be a factor in developing Microscopic Colitis.

Studies have shown that vitamin D helps to create a balance between your body’s immune response and its anti inflammatory response. It does this by helping to regulate the levels of T cells and B cells in the body. In other words, having an adequate amount of vitamin D in your system can help to keep your immune system from wreaking havoc on your body. (4)

However, it is also possible vitamin D deficiency is a result of having an IBD instead of being a cause. Irritable bowel disease has been known to cause malabsorption in many patients, which means the body is not absorbing nutrients as it should. This includes vitamin D. Once again, more research is needed.

Another Reason To Quit Smoking

Smokers are far more likely to develop Microscopic Colitis than non-smokers. Smokers also tend to develop Microscopic Colitis an average of 10 years earlier than non-smokers and tend to suffer more pain during flare-ups. (5)

Smoking is widely known to be an irritant that causes inflammation throughout the body. It also reduces blood flow to tissue and organs, including the colon. So smoking might not only contribute the damage that leads to Microscopic Colitis, but it might also prevent the body from healing itself.

Conclusion

Microscopic Colitis has been considered a rare disease up until the last couple of years, and therefore has not been the focus of many studies. Those that they have done have been small and therefore provide no definitive answers.

Doctors know that there’s a connection between these factors and having Microscopic Colitis, but they don’t know the how or why behind any of it.

Many of these factors are much like the old question–which came first? The chicken or the egg? In other words, is Microscopic Colitis the result or the cause?

The only thing we do know for sure is that a lot more research needs to be done.

Sources

(1) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4265085/#bibr79-1756283X14550134

(2) University of Gothenburg. “New theory on why more women than men develop autoimmune diseases.” ScienceDaily. ScienceDaily, 5 June 2018.

(3) https://www.niddk.nih.gov/health-information/digestive-diseases/microscopic-colitis?dkrd=hispt0266

(4) Sjöberg K., Vigren K., Roth B., Malm J., Manjer J., Almquist M., et al. (2013) Vitamin D levels in microscopic colitis. Scand J Gastroenterol 48: 987–988.

(5) Vigren L., Sjoberg K., Benoni C., Tysk C., Bohr J., Kilander A., et al. (2011) Is smoking a risk factor for collagenous colitis? Scan J Gastroenterol 46: 1334–1339