Microscopic colitis: a review

• Published in: Colorectal disease 2014-12, Vol.16 (12), p.957-964
• Main Authors: Farrukh, A., Mayberry, J. F.
• Format: Article
• Language: English
• Subjects: aetiology treatment; Age Factors; Anti-Inflammatory Agents - therapeutic use; Antidiarrheals - therapeutic use; Colitis, Microscopic - drug therapy; Colitis, Microscopic - epidemiology; Colitis, Microscopic - etiology; Diarrhea - drug therapy; Diarrhea - etiology; epidemiology; Humans; Immunosuppressive Agents - therapeutic use; Incidence; microscopic colitis; Prevalence; Probiotics - therapeutic use; Sex Factors
• ISSN: 1462-8910; 1463-1318
• DOI: 10.1111/codi.12716

Aim In recent years, microscopic colitis has been increasingly diagnosed. This review was carried out to evaluate demographic factors for microscopic colitis and to perform a systematic assessment of available treatment options. Method Relevant publications up to December 2013 were identified following searches of PubMed and Google Scholar using the key words ‘microscopic colitis’, ‘collagenous colitis’ and ‘lymphocytic colitis’. Two‐hundred and forty‐eight articles were identified. Results The term microscopic colitis includes lymphocytic colitis and collagenous colitis. Both have common clinical symptoms but are well defined histopathologically. The clinical course is usually benign, but serious complications, including death, may occur. A peak incidence from 60 to 70 years of age with a female preponderance is observed. Although most cases are idiopathic, associations with autoimmune disorders, such as coeliac disease and hypothyroidism, as well as with exposure to nonsteroidal anti‐inflammatory drugs and proton‐pump inhibitors, have been observed. The incidence and prevalence of microscopic colitis is rising and good‐quality epidemiological research is needed. Treatment is currently largely based on anecdotal evidence and on results from limited clinical trials of budesonide. Long‐term follow‐up of these patients is not well established. Conclusion The review synthesizes work on the definition of microscopic colitis and the relationship between collagenous and lymphocytic colitis. It reviews the international epidemiology and work on aetiology. In addition, it critically considers the efficacy of a range of treatments.