Diagnosis and treatment of microscopic colitis

Abstract

Microscopic colitis (MC) designates two types of chronic diarrhea diseases, which are lymphocytic colitis and collagenous colitis. The prevalence of microscopic colitis is increasing in both Western and Eastern countries, possibly due to the high incidence of colonoscopic survey in chronic diarrhea patients. Although the overall prognosis of MC patients is mostly good, it should be noted that appropriate diagnosis and choice of treatment is required to assure a good clinical outcome for MC patients. Also, a certain population of MC patients may take a severe and refractory clinical course, and thus require advanced clinical care using medications supported by less evidence. In this review, we would like to feature the essential points regarding the diagnosis of MC, and also describe the current standard of treatments for MC patients. In addition, we would like to add some findings from the national survey and research carried out in Japan, to compare those data with the western countries.

Macroscopic Findings in Microscopic Colitis: Two Case Reports and a Review of Literature

“…Several medications have been associated with drug induced microscopic colitis. Proton-pump inhibitors (PPI) appear to have the strongest association [5]. In a study done by Beaugerie and Pardi, 10 medications including PPIs, Non steroidal anti inflammatory drugs (NSAIDs), and selective serotonin receptor inhibitors (SSRIs) were ranked as high-risk drugs for developing MC [8].…”

“…In mild cases, discontinuation of medications and use of anti diarrheal medications can lead to resolution [5]. Data from randomized trials indicates that Budesonide (9mg up to 8 weeks) increased the probability of experiencing clinical remission by 152% after 6 to 8 months of follow-up (RR, 2.52; 95% CI, 1.45-4.4).…”

“…As awareness and understanding of MC has improved over time, it's documented incidence and prevalence has increased. Although MC was initially conceived to be a histopathologic diagnosis, recent studies have shown specific endoscopic findings that can be associated with MC [4,5]. We report two cases of biopsy proven collagenous colitis that had macroscopic features on endoscopic examination.…”

Diagnostic Algorithm and Treatment for Microscopic Colitis: A Review.

“…The diagnosis of MC and assessment should begin from the onset of clinical symptoms (chronic or intermittent relapsing watery, non-bloody diarrhea) (Macaigne et al 2014) (Okamoto et al 2016) (Ingle 2014). If such a symptom appears in a woman over the age of 50, diagnosis of MC should be highly suspected (Macaigne et al 2014) (Okamoto et al 2016) (Ingle 2014). Also, if there is a newly started drug or a concomitant autoimmune disease will support the possible diagnosis of MC (Macaigne et al 2014) (Okamoto et al 2016) (Ingle 2014).…”

“…If such a symptom appears in a woman over the age of 50, diagnosis of MC should be highly suspected (Macaigne et al 2014) (Okamoto et al 2016) (Ingle 2014). Also, if there is a newly started drug or a concomitant autoimmune disease will support the possible diagnosis of MC (Macaigne et al 2014) (Okamoto et al 2016) (Ingle 2014). Diagnosis of MC depends on a proper medical history, with the exclusion of other diseases, background disease, drug consumption history, normal radiological, normal or almost normal endoscopic findings and endoscopic biopsies with histopathological findings consistent with MC (Macaigne et al 2014) (Okamoto et al 2016) (Ingle 2014).…”