Biomarkers and Microscopic Colitis: An Unmet Need in Clinical Practice

Abstract

One of the most common causes of chronic diarrhea is ascribed to microscopic colitis (MC). MC is classified in subtypes: collagenous colitis (CC) and lymphocytic colitis (LC). Patients with MC report watery, non-bloody diarrhea of chronic course, abdominal pain, weight loss, and fatigue that may impair patient’s health-related quality of life. A greater awareness, and concomitantly an increasing number of diagnoses over the last years, has demonstrated that the incidence and prevalence of MC are on the rise. To date, colonoscopy with histological analysis on multiple biopsies collected along the colon represents the unique accepted procedure used to assess the diagnosis of active MC and to evaluate the response to medical therapy. Therefore, the emerging need for less-invasive procedures that are also rapid, convenient, standardized, and reproducible, has encouraged scientists to turn their attention to the identification of inflammatory markers and other molecules in blood or feces and within the colonic tissue that can confirm a MC diagnosis. This review gives an update on the biomarkers that are potentially available for the identification of inflammatory activity, related to CC and LC.

Diagnostic Algorithm and Treatment for Microscopic Colitis: A Review.

“…Despite frequent diarrhoea, laboratory tests are usually normal or disclose unspecific abnormalities (Fischer et al 2015) (Pisani et al 2017). Until this moment, no reliable serum marker has been identified in MC (Pisani et al 2017).…”

“…Until this moment, no reliable serum marker has been identified in MC (Pisani et al 2017). The common serological inflammatory marker, such as C-Reactive Protein is usually normal or only slightly elevated in MC (Roth, Gustafsson, and Ohlsson 2013).…”

“…Series of clinical studies have shown that those patients with MC are more than 50 years of age, report weight loss, have a duration of diarrhea < 12 months, have recently taken a new drug, and have a coexisting autoimmune disease(s) (Macaigne et al 2014) (Cotter et al 2016) (Kane et al 2015). From present literature it has to be assumed that there is an emerging need to identify a non-invasive diagnostic tool that can predict the presence of active MC and distinguish MC from other functional and organic causes of watery diarrhea (Cotter et al 2016) (Pisani et al 2017) (Macaigne et al 2014). Such a diagnostic tool would furthermore serve to better assess the real need for colonoscopy and histological evaluation (Pisani et al 2017) (Macaigne et al 2014) (Kane et al 2015).…”

“…From present literature it has to be assumed that there is an emerging need to identify a non-invasive diagnostic tool that can predict the presence of active MC and distinguish MC from other functional and organic causes of watery diarrhea (Cotter et al 2016) (Pisani et al 2017) (Macaigne et al 2014). Such a diagnostic tool would furthermore serve to better assess the real need for colonoscopy and histological evaluation (Pisani et al 2017) (Macaigne et al 2014) (Kane et al 2015). As a matter of fact, this non-invasive test should be rapid, inexpensive, standardized, reproducible, and accurate in reflecting the predominant lymphocytic activity in the large bowel of patients suffering from MC (Pisani et al 2017).…”

“…Such a diagnostic tool would furthermore serve to better assess the real need for colonoscopy and histological evaluation (Pisani et al 2017) (Macaigne et al 2014) (Kane et al 2015). As a matter of fact, this non-invasive test should be rapid, inexpensive, standardized, reproducible, and accurate in reflecting the predominant lymphocytic activity in the large bowel of patients suffering from MC (Pisani et al 2017). …”