현미경적 대장염
Microscopic Colitis
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초록
현미경적 대장염은 임상적으로 만성 설사를 주소로 내원한 환자에서 생화학 검사, 내시경 검사 등에서 특이소견을보이지 않지만 조직 검사를 이용하여 진단할 수 있다. 증상은 과민성 장증후군을 포함한 기능성 질환과 유사할 수 있기에 본 질병의 가능성을 고려하여 감별 진단하려는 노력이중요하다. 병인으로 만성 염증, 섬유화 기전 이상, 자가면역, 약제, 세균, 담즙산 등 다양한 원인이 관여할 수 있다. 보존적 치료, 지사제, 스테로이드, 면역억제제 등을 사용하지만질병의 중증도와 약제의 부작용 및 근거를 고려하여 환자의증상과 삶의 질을 호전시킬 수 있는 적절한 치료 전략을 수립해야만 한다(Fig. 2) [106]. 대부분 경한 예후를 보이지만 일부 환자에서 설사의 재발 및 만성 경과를 나타낼 수 있다.
Abstract
Microscopic colitis (MC) is a chronic idiopathic inflammatory bowel disease presenting with chronic watery diarrhea. Epidemiologic studies from Western countries have demonstrated that it is almost as common as other classic inflammatory bowel diseases, such as Crohn’s disease and ulcerative colitis. Histological examination can confirm the diagnosis and differentiate between the two main subtypes of MC: collagenous colitis and lymphocytic colitis. The pathophysiology of MC remains unknown; however, possible etiologies include genetic predispositions, autoimmunity, inflammatory responses to luminal factors such as certain drugs or bacteria, and myofibroblast dysregulations. The aim of MC therapy should take into account the severity of symptoms, impact on quality of life, and evidence from clinical trials of available medical treatments.
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