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Hi all - The following excerpt is forwarded with the permission of Judy
Malinowski, who runs the online CCClub Newsletter:

CCClub Newsletter #108
17 Dec. 1998
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Report from Dr. Fine on the relationship of microscopic colitis to celiac
sprue

About 2000 years ago a famous physician named Aretaeus living in a country
called Cappadocia (now in present-day Turkey) made some strikingly accurate
observations. As documented in his translated writings, he noticed there
were pale emaciated individuals that for no obvious reason experienced
heavy pains of the stomach, and diarrhea, consisting of undigested food in
a fluid state. Aretaeus called this syndrome "The Coeliac Affection." Today
we know it similarly as celiac disease or celiac sprue.

Although not known 2000 years ago, we now know that the small intestinal
disease, celiac sprue, is caused by a dietary protein called gluten derived
from wheat, barley, rye, and oats. If this disorder is not recognized and
properly treated, patients experience chronic diarrhea, weight loss, bone
mineral loss, malnutrition, anemia from vitamin/iron deficiencies, and
muscle emaciation. It is treated by a rigorous diet that eliminates the
grains containing gluten from the diet.

In a research study conducted and reported last year, we discovered that
microscopic colitis was responsible for most cases of chronic diarrhea
after patients with celiac sprue were diagnosed and treated (published in
the journal Gastroenterology June1997, volume 112, pages 1830-1838). This
year we have discovered why this is so. It turns out that the same gene
that predisposes to celiac sprue also predisposes to the development of the
microscopic colitis syndrome (both the collagenous and lymphocytic types).
This means that patients with sprue can get microscopic colitis (which we
already knew) but also that patients with microscopic colitis can get
celiac sprue. However, the gluten sensitivity in colitis patients may not
display classic features but instead may be so mild that it cannot even be
diagnosed by current methods. We are working on a more "molecular" method
to diagnose occult gluten sensitivity.

It is my opinion that everyone with microscopic colitis should have the
blood tests looking for celiac sprue/gluten sensitivity, especially if your
colitis has been difficult to treat or if you have had early relapses after
successful treatment with Pepto Bismol or another agent. There are three
blood tests: Antigliadin antibodies of two types: IgG and IgA, and
antiendomysial antibody (IgA). I will relate more details as they develop.

Our next treatment study (hopefully to be started in 1-2 months) has had
built into the protocol tests to insure that patients with microscopic
colitis do not have celiac sprue also.

Thank you for your interest.

Kenneth Fine, M.D.

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FYI: Dr. Fine is at Baylor in Texas.
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