European guidelines on microscopic colitis: United European Gastroenterology and European Microscopic Colitis Group statements and recommendations

Abstract

Introduction Microscopic colitis is a chronic inflammatory bowel disease characterised by normal or almost normal endoscopic appearance of the colon, chronic watery, non-bloody diarrhoea and distinct histological abnormalities, which identify three histological subtypes, the collagenous colitis, the lymphocytic colitis and the incomplete microscopic colitis. With ongoing uncertainties and new developments in the clinical management of microscopic colitis, there is a need for evidence-based guidelines to improve the medical care of patients suffering from this disorder. Methods Guidelines were developed by members from the European Microscopic Colitis Group and United European Gastroenterology in accordance with the Appraisal of Guidelines for Research and Evaluation II instrument. Following a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation methodology was used to assess the certainty of the evidence. Statements and recommendations were developed by working groups consisting of gastroenterologists, pathologists and basic scientists, and voted upon using the Delphi method. Results These guidelines provide information on epidemiology and risk factors of microscopic colitis, as well as evidence-based statements and recommendations on diagnostic criteria and treatment options, including oral budesonide, bile acid binders, immunomodulators and biologics. Recommendations on the clinical management of microscopic colitis are provided based on evidence, expert opinion and best clinical practice. Conclusion These guidelines may support clinicians worldwide to improve the clinical management of patients with microscopic colitis.

Novel Case Report: A Previously Reported, but Pathophysiologically Unexplained, Association Between Collagenous Colitis and Protein-Losing Enteropathy May Be Explained by an Undetected Link with Collagenous Duodenitis

“…A minor criticism is that the patient’s collagenous colitis was treated about 1 year ago with budesonide and mesalamine. Mesalamine has recently been delisted as recommended therapy for collagenous colitis [ 38 ]. Strengths of this work include a strongly positive diagnosis of PLE by alpha-1 antitrypsin levels, a strongly positive pathologic diagnosis of CD, and exclusion of other major causes of hypoalbuminemia and anasarca aside from PLE.…”

Editorial: microscopic colitis linked to NSAIDs but not proton pump inhibitors

“…According to the 2020 European Microscopic Colitis Group, 'Chronic or frequent use of proton pump inhibitors (PPIs), non-steroidal anti-inflammatory drugs (NSAIDs) or selective serotonin reuptake inhibitors (SSRIs) is associated with an increased risk of MC'. 5 The guidelines also stipulate that no causal relationship has been established because the evidence ranges from individual case reports to observational studies. 3 Zylberberg et al 6 conducted a retrospective case-control study with 344 patients and 668 controls to assess the association between medication use and MC.…”

“…The role of drugs in the pathogenesis of MC is controversial. According to the 2020 European Microscopic Colitis Group, ‘Chronic or frequent use of proton pump inhibitors (PPIs), non‐steroidal anti‐inflammatory drugs (NSAIDs) or selective serotonin reuptake inhibitors (SSRIs) is associated with an increased risk of MC’ 5 . The guidelines also stipulate that no causal relationship has been established because the evidence ranges from individual case reports to observational studies 3 …”

Faecal microbiota transfer in patients with microscopic colitis – a pilot study in collagenous colitis

“…Both types are characterised by a macroscopically normal or almost normal mucosa; however, microscopically an increased number of lymphocytes can be observed. The colonic mucosa of CC patients also shows a thickened subepithelial collagen layer [2,3]. Currently, the most effective medication to treat MC is budesonide, a synthetic glucocorticoid.…”