Microscopic Colitis Diagnosis and Management

Microscopic colitis is an inflammatory condition of the large bowel presenting predominantly with chronic, non-bloody, watery diarrhoea. It comprises two main histological subtypes: collagenous colitis, characterised by a thickened subepithelial collagen band, and lymphocytic colitis, defined by an increased density of intraepithelial lymphocytes. Endoscopic appearance is typically normal or minimally altered, making diagnosis dependent on systematic biopsy sampling throughout the colon. Histological assessment remains the gold standard, with multiple specimens taken from right and left colon to capture focal changes. Epidemiological studies indicate rising incidence, particularly among older women, and associations with autoimmunity, medication use (for example proton-pump inhibitors and nonsteroidal anti-inflammatory drugs) and smoking. Management combines symptom control with mucosal healing. Budesonide, a release-controlled glucocorticoid with high first-pass metabolism, is first-line treatment, inducing remission in the majority of patients. In refractory cases, systemic corticosteroids, bile acid sequestrants or immunomodulators may be employed. Maintenance regimens are tailored to relapse risk and side-effect profiles. Emerging research highlights the need for non-invasive biomarkers, optimised sampling protocols and recognition of extraintestinal comorbidities which influence long-term outcomes.

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Microscopic Colitis Diagnosis and Management publication trend

The graph below shows the total number of articles in microscopic colitis diagnosis and management across all publications each year (not limited to Nature Index journals).

Technical terms

Collagenous colitis: A subtype of microscopic colitis defined by a subepithelial collagen layer exceeding 10 µm accompanied by lamina propria inflammation.

Lymphocytic colitis: A form of microscopic colitis characterised by more than 20 intraepithelial lymphocytes per 100 epithelial cells with associated inflammatory infiltrate.

Histopathology: Microscopic examination of tissue structure and cellular detail used to confirm diagnosis and subtype of microscopic colitis.

Budesonide: A glucocorticoid with high topical potency and low systemic bioavailability, used as first-line induction and maintenance therapy in microscopic colitis.

Faecal calprotectin: A neutrophil-derived protein measured in stool that serves as a non-invasive marker of intestinal inflammation but may be normal in active microscopic colitis.

References

1. Mucosal and faecal neutrophil gelatinase-associated lipocalin as potential biomarkers for collagenous colitis. Journal of Gastroenterology (2021).
2. Microscopic colitis: controversies in clinical symptoms and autoimmune comorbidities. Annals of Medicine (2021).
3. Patients With Microscopic Colitis Are at Higher Risk of Major Adverse Cardiovascular Events: A Matched Cohort Study. Clinical Gastroenterology and Hepatology (2023).