Endgames Case report

Microscopic colitis in primary care

BMJ 2010; 340 doi: http://dx.doi.org/10.1136/bmj.b5520 (Published 07 January 2010) Cite this as: BMJ 2010;340:b5520
  1. Kamal R Mahtani, academic clinical fellow1,
  2. Peter W Rose, university lecturer1,
  3. Niall van Someren, consultant gastroenterologist2
  1. 1Department of Primary Health Care, University of Oxford, Oxford OX3 7LF
  2. 2Department of Medicine, Chase Farm Hospital, Enfield, Middlesex EN2 8JL
  1. Correspondence: K R Mahtani kamal.mahtani{at}dphpc.ox.ac.uk

    A 70 year old man presented to his general practitioner in December 2008 because of a nasal sinus problem. He also mentioned that his stool frequency had increased to three to four times a day, which was unusual for him. These symptoms were associated with increased flatulence and occasional cramping, but he gave no history of passing blood per rectum. His examination was unremarkable, so he was started on a course of mebeverine and asked to return if his symptoms persisted.

    In February the patient consulted again, specifically about his diarrhoea. He still had episodes of diarrhoea, often three to four times a day, which lasted a few days and occurred two or three times each month before spontaneous resolution. His medical history, family history, and drug history were also unremarkable. His examination was again unremarkable and he had not lost weight.

    He was sent for a blood test at the practice. Liver function, C reactive protein, thyroid and endomysial IgA antibodies (he had been on a gluten containing diet) tests were all normal. His full blood count showed a haemoglobin of 129 g/l, mean corpuscular volume of 90.8 fl, and a total white cell count of 4.1×109/l. Because of the change in bowel habit and his age he was referred to the local colorectal team via the two week wait system.

    The patient underwent oesophagogastroduodenoscopy and colonoscopy with biopsy to exclude malignancy. Oesophagogastroduodenoscopy and colonoscopy were macroscopically normal. His colon histopathology report showed increased collagen deposition below the surface epithelium, intraepithelial lymphocytosis, and a moderate excess of chronic inflammatory cells in the lamina propria. No dysplastic or malignant changes, parasites, or granulomatous changes were seen. The appearances were thought to be consistent with microscopic colitis of combined collagenous and lymphocytic colitis type.

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