Prevalence, Pathogenesis, Diagnosis, and Management of Microscopic Colitis

Abstract

Microscopic colitis (MC), which is comprised of lymphocytic colitis and collagenous colitis, is a clinicopathological diagnosis that is commonly encountered in clinical practice during the evaluation and management of chronic diarrhea. With an incidence approaching the incidence of inflammatory bowel disease, physician awareness is necessary, as diagnostic delays result in a poor quality of life and increased health care costs. The physician faces multiple challenges in the diagnosis and management of MC, as these patients frequently relapse after successful treatment. This review article outlines the risk factors associated with MC, the clinical presentation, diagnosis and histologic findings, as well as a proposed treatment algorithm. Prospective studies are required to better understand the natural history and to develop validated histologic endpoints that may be used as end points in future clinical trials and serve to guide patient management.

Keywords: Colitis, collagenous; Colitis, lymphocytic; Colitis, microscopic.

Fig. 1

Lymphocytic colitis. Images of H&E staining showing intraepithelial lymphocytosis and a preserved colonic architecture (×20).

Fig. 2

Collagenous colitis. Images of H&E staining showing a thickened subepithelial collagen band (arrows) and a preserved colonic architecture (×40).

Fig. 3

Management of microscopic colitis (MC) according to symptom severity. NSAIDs, nonsteroidal anti-inflammatory drugs.