. 2021 Feb 22;9(1):13-37.

doi: 10.1177/2050640620951905. Online ahead of print.

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

Stephan Miehlke^{1

2}, Danila Guagnozzi^{3

4

5

6}, Yamile Zabana^{6

7}, Gian E Tontini⁸, Anne-Marie Kanstrup Fiehn⁹, Signe Wildt^{10

11}, Johan Bohr¹², Ole Bonderup¹³, Gerd Bouma¹⁴, Mauro D'Amato¹⁵, Peter J Heiberg Engel¹⁶, Fernando Fernandez-Banares^{6

7}, Gilles Macaigne¹⁷, Henrik Hjortswang^{18

19}, Elisabeth Hultgren-Hörnquist²⁰, Anastasios Koulaouzidis²¹, Jouzas Kupcinskas²², Stefania Landolfi²³, Giovanni Latella²⁴, Alfredo Lucendo²⁵, Ivan Lyutakov²⁶, Ahmed Madisch²⁷, Fernando Magro²⁸, Wojciech Marlicz²⁹, Emese Mihaly³⁰, Lars K Munck^{10

11}, Ann-Elisabeth Ostvik^{31

32}, Árpád V Patai^{33

34}, Plamen Penchev²⁶, Karolina Skonieczna-Żydecka³⁵, Bas Verhaegh³⁶, Andreas Münch^{18

19}

Affiliations

¹ Center for Digestive Diseases, Internal Medicine Center Eppendorf, Hamburg, Germany.
² Center for Esophageal Disorders, University Hospital Eppendorf, Hamburg, Germany.
³ Neuro-Immuno-Gastroenterology Group, Digestive Physiology and Pathophysiology Unit, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.
⁴ Digestive System Department, Vall d'Hebron University Hospital, Barcelona, Spain.
⁵ Faculty of Medicine, Autonomous University of Barcelona, Bellaterra, Spain.
⁶ Centro de Investigación Biomedica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.
⁷ Department of Gastroenterology, Hospital Universitari Mutua de Terrassa, University of Barcelona, Barcelona, Spain.
⁸ Department of Pathophysiology and Organ Transplantation, University of Milan and Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
⁹ Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Denmark.
¹⁰ Department of Gastroenterology, Zealand University Hospital, Koege, Denmark.
¹¹ Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
¹² Department of Medicine, Örebro University Hospital, Örebro University, Örebro, Sweden.
¹³ Diagnostik Center, Hospitalenhed Midt, Regionshospitalet Silkeborg, Silkeborg, Denmark.
¹⁴ Department of Gastroenterology and Hepatology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
¹⁵ School of Biological Sciences, Monash University, Clayton, Australia.
¹⁶ Department of Pathology, Zealand University Hospital, Roskilde, Denmark.
¹⁷ Hepatogastroenterology Unit, Centre Hospitalier de Marne-la-Vallee, Jossigny, France.
¹⁸ Department of Gastroenterology and Hepatology in Linköping, Linköping University, Linköping, Sweden.
¹⁹ Department of Health, Medicine, and Caring Sciences, Linköping University, Linköping, Sweden.
²⁰ School of Medical Sciences, Örebro University, Örebro, Sweden.
²¹ The Royal Infirmary of Edinburgh, Endoscopy Unit, Edinburgh, UK.
²² Department of Gastroenterology and Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania.
²³ Department of Pathology, Hospital Universitari Vall d'Hebron, CIBERONC, Barcelona, Spain.
²⁴ Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.
²⁵ Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Spain.
²⁶ Department of Gastroenterology, Medical University of Sofia, University Hospital Tsaritsa Yoanna-ISUL, Sofia, Bulgaria.
²⁷ Department of Gastroenterology, CRH Clinic Siloah, Hannover, Germany.
²⁸ Department of Pharmacology, Hospital de Sao Joao, Porto, Portugal.
²⁹ Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland.
³⁰ Department of Internal Medicine, Semmelweis University, Budapest, Hungary.
³¹ Department of Clinical and Molecular Medicine, NTNU: Norwegian University of Science and Technology, Trondheim, Norway.
³² Department of Gastroenterology and Hepatology, St Olav's University Hospital, Trondheim, Norway.
³³ 2nd Department of Medicine, Semmelweis University, Budapest, Hungary.
³⁴ Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
³⁵ Department of Human Nutrition and Metabolomics, Pomeranian Medical University, Szczecin, Poland.
³⁶ Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.

PMID: 33619914
PMCID: PMC8259259
DOI: 10.1177/2050640620951905

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

Stephan Miehlke et al. United European Gastroenterol J. 2021.

. 2021 Feb 22;9(1):13-37.

doi: 10.1177/2050640620951905. Online ahead of print.

Authors

Affiliations

¹ Center for Digestive Diseases, Internal Medicine Center Eppendorf, Hamburg, Germany.
² Center for Esophageal Disorders, University Hospital Eppendorf, Hamburg, Germany.
³ Neuro-Immuno-Gastroenterology Group, Digestive Physiology and Pathophysiology Unit, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.
⁴ Digestive System Department, Vall d'Hebron University Hospital, Barcelona, Spain.
⁵ Faculty of Medicine, Autonomous University of Barcelona, Bellaterra, Spain.
⁶ Centro de Investigación Biomedica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.
⁷ Department of Gastroenterology, Hospital Universitari Mutua de Terrassa, University of Barcelona, Barcelona, Spain.
⁸ Department of Pathophysiology and Organ Transplantation, University of Milan and Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
⁹ Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Denmark.
¹⁰ Department of Gastroenterology, Zealand University Hospital, Koege, Denmark.
¹¹ Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
¹² Department of Medicine, Örebro University Hospital, Örebro University, Örebro, Sweden.
¹³ Diagnostik Center, Hospitalenhed Midt, Regionshospitalet Silkeborg, Silkeborg, Denmark.
¹⁴ Department of Gastroenterology and Hepatology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
¹⁵ School of Biological Sciences, Monash University, Clayton, Australia.
¹⁶ Department of Pathology, Zealand University Hospital, Roskilde, Denmark.
¹⁷ Hepatogastroenterology Unit, Centre Hospitalier de Marne-la-Vallee, Jossigny, France.
¹⁸ Department of Gastroenterology and Hepatology in Linköping, Linköping University, Linköping, Sweden.
¹⁹ Department of Health, Medicine, and Caring Sciences, Linköping University, Linköping, Sweden.
²⁰ School of Medical Sciences, Örebro University, Örebro, Sweden.
²¹ The Royal Infirmary of Edinburgh, Endoscopy Unit, Edinburgh, UK.
²² Department of Gastroenterology and Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania.
²³ Department of Pathology, Hospital Universitari Vall d'Hebron, CIBERONC, Barcelona, Spain.
²⁴ Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.
²⁵ Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Spain.
²⁶ Department of Gastroenterology, Medical University of Sofia, University Hospital Tsaritsa Yoanna-ISUL, Sofia, Bulgaria.
²⁷ Department of Gastroenterology, CRH Clinic Siloah, Hannover, Germany.
²⁸ Department of Pharmacology, Hospital de Sao Joao, Porto, Portugal.
²⁹ Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland.
³⁰ Department of Internal Medicine, Semmelweis University, Budapest, Hungary.
³¹ Department of Clinical and Molecular Medicine, NTNU: Norwegian University of Science and Technology, Trondheim, Norway.
³² Department of Gastroenterology and Hepatology, St Olav's University Hospital, Trondheim, Norway.
³³ 2nd Department of Medicine, Semmelweis University, Budapest, Hungary.
³⁴ Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
³⁵ Department of Human Nutrition and Metabolomics, Pomeranian Medical University, Szczecin, Poland.
³⁶ Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.

PMID: 33619914
PMCID: PMC8259259
DOI: 10.1177/2050640620951905

Abstract

Introduction: Microscopic colitis is a chronic inflammatory bowel disease characterised by normal or almost normal endoscopic appearance of the colon, chronic watery, nonbloody 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.

Keywords: budesonide; diarrhoea; inflammatory bowel disease; microscopic colitis.

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Conflict of interest statement

There are no industry or government relationships to report: Johan Bohr, Mauro D'Amato, JE, Anne‐Marie Kanstrup Fiehn, Jouzas Kupcinskas, Giovanni Latella, Ivan Lyutakov, Gilles Macaigne, Fernando Magro, Emese Mihaly, Lars Kristian Munck, Árpád V. Patai, Karolina Skonieczna‐Zydecka, Bas Verhaegh. Advisory boards, consulting: Stephan Miehlke: Dr Falk Pharma, Tillotts; Yamile Zabana: Tillotts, Janssen, FAES; Fernando Fernandez‐Banares: Tillotts, Thermofisher; Henrik Hjortswang: Abbvie, Janssen, Pfizer, Takeda, Tillotts; Anastasios Koulaouzidis: Tillotts, Dr Falk Pharma; Wojciech Marlicz Sanprobi; Ahmed Madisch: Dr Falk Pharma; Ole Bonderup: Tillotts; Gian E. Tontini: Aorta SRL, CapsoVision Inc; Andreas Münch: Ferring, Tillotts, Dr Falk Pharma; Signe Wildt: Tillotts, Takeda. Research grants/clinical trial funding: Ole Bonderup: Tillotts; Fernando Fernandez‐Banares: Dr Falk Pharma; Henrik Hjortswang: Abbvie, Ferring, Tillotts, Biomedal; Andreas Münch: Ferring. Speaker's bureau: Stephan Miehlke: Dr Falk Pharma/Falk Foundation; Yamile Zabana: Abbvie, MSD, Ferring; Danila Guagnozzi: Allergan; Ole Bonderup: Dr Falk Pharma/Falk Foundation, Tillotts; Henrik Hjortswang: Abbvie, Tillotts; Anastasios Koulaouzidis: Dr Falk Pharma; Ahmed Madisch: Dr Falk Pharma/Falk Foundation; Wojciech Marlicz: Alfasigma; Andreas Münch: Tillotts.

Figures

**FIGURE 1**
Therapeutic algorithm for microscopic colitis in clinical practice. *Smoking, NSAID, PPI; **for example bile acid diarrhoea, coeliac disease. NSAID, nonsteroidal anti‐inflammatory drugs; PPI, proton pump inhibitor

See this image and copyright information in PMC

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

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

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