Do gluten sensitivity and microscopic colitis go hand in hand? For this article I interviewed Matilda N. Hagan, MD, an inflammatory bowel disease specialist at The Center for Inflammatory Bowel and Colorectal Diseases, part of The Melissa L. Posner Institute for Digestive Health and Liver Disease at Mercy Medical Center in Baltimore.
Here is what Dr. Hagan explains: “There is an association between microscopic colitis and celiac disease for reasons that are not clear. Microscopic colitis tends to affect older women in their sixth decade or older.
“However, younger patients with celiac disease can have microscopic colitis at the same time.
“In fact, if you have celiac disease and have persistent symptoms despite a gluten free diet we test for MC. Also if someone with MC is not responding to our best treatment we test for celiac disease.”
Microscopic colitis is believed (though not proven) to be an autoimmune disease.
Celiac disease is definitely an autoimmune condition, in which the body’s immune system “thinks” that gluten—a type of protein in certain grains—is a foreign invader of some sort.
Thus, even one crumb of gluten triggers an immune response, and this response, over time, damages the small intestine and causes other problems throughout the body, unless the patient ceases gluten ingestion completely.
There is a higher percentage of diagnosed microscopic colitis in celiac patients and vice versa, so yes, there is an association, but the details have yet to be discovered.
A person with microscopic colitis (which is confirmed via large-colon biopsy) can always undergo genetic testing to see if they have the gene/s for celiac disease. If you do not have one of these genes, you cannot develop celiac disease.
However, this doesn’t mean that you cannot ever develop gluten sensitivity (which is not the same as celiac and is far less damaging).
The verdict is not out whether or not those with microscopic colitis should avoid gluten, even though doing this may relieve symptoms in some patients.