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Review
. 2011;24(4):253-262.

Recent advances in diagnosis and treatment of microscopic colitis

Curt Tysk  1 , Anna Wickbom  1 , Nils Nyhlin  1 , Sune Eriksson  2 , Johan Bohr  1
Affiliations
Review

Recent advances in diagnosis and treatment of microscopic colitis

Curt Tysk et al. Ann Gastroenterol. 2011.

Abstract

Microscopic colitis, comprising collagenous colitis and lymphocytic colitis, is a common cause of chronic diarrhea. It is characterized clinically by chronic watery diarrhea and a macroscopically normal colonic mucosa where diagnostic histopathological features are seen on microscopic examination. The annual incidence of each disorder is 4-6/100,000 inhabitants, with a peak incidence in individuals 60-70 years old and a noticeable female predominance in collagenous colitis. The etiology is unknown. Chronic diarrhea, abdominal pain, weight loss, fatigue, and fecal incontinence are common symptoms that impair the health-related quality of life of the patient. There is an association with other autoimmune disorders, such as celiac disease, thyroid disorders, diabetes mellitus, and arthritis. Budesonide is the best-documented treatment, both short-term and long-term. Recurrence of symptoms is common after withdrawal of successful budesonide therapy, and the optimal long-term treatment strategy needs further study. The long-term prognosis is good, and the risk of complications including colon cancer is low. We review the epidemiology, clinical features, diagnosis and treatment of microscopic colitis.

Keywords: Microscopic colitis; budesonide; chronic diarrhea; collagenous colitis; lymphocytic colitis.

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Conflict of interest statement

Conflict of Interest: None

Figures

Figure 1
Figure 1
Age- and sex-specific incidence of (A) collagenous colitis and (B) lymphocytic colitis. Reprinted with permission from Gut 2004;53:346-50
Figure 2
Figure 2
Biopsy from colon showing (A, B) typical findings of collagenous colitis - increased subepithelial collagen layer, inflammation of lamina propria, and epithelial cell damage with intraepithelial lymphocytes; (C) typical findings of lymphocytic colitis - epithelial cell damage with intraepithelial lymphocytes, inflammation in the lamina propria but no increased collagen layer
Figure 3
Figure 3
Tenascin immunostaining in collagenous colitis
Figure 4
Figure 4
Immunostaining of CD3+ T-lymphocytes in lymphocytic colitis
See this image and copyright information in PMC

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