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Microscopic colitis
Peter Tagkalidis1, Prithi Bhathal, Peter Gibson
1Department of Gastroenterology, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia. peter.tagkalidis@mh.org.au
Abstract:
Microscopic colitis is an umbrella term used to include two idiopathic inflammatory bowel disorders that present with chronic watery diarrhea, normal endoscopic findings and characteristic inflammatory changes on histology. Collagenous colitis and lymphocytic colitis are distinguished by the presence of a thickened subepithelial collagen table. It is likely that they are a spectrum of one disease, but this is yet to be proven. The majority of cases tend to undergo spontaneous remission within a few years of onset, and their clinical course is benign, with no increase in risk of colorectal cancer. Sufficient evidence exists to suggest that microscopic colitis occurs as a response to one or more luminal antigens. A variety of medications have been reported in the treatment of this condition, but only colloidal bismuth and budesonide have thus far been shown to be effective in randomized controlled trials.
Insights
Microscopic colitis, encompassing collagenous and lymphocytic colitis, causes chronic watery diarrhea. While often self-remitting and benign, specific treatments like budesonide show efficacy.
Area of Science:
- Gastroenterology
- Histopathology
Background:
- Microscopic colitis includes collagenous and lymphocytic colitis, characterized by chronic watery diarrhea and normal endoscopy.
- Histological examination reveals characteristic inflammatory changes, distinguishing it from other bowel disorders.
Purpose of the Study:
- To summarize the understanding of microscopic colitis, including its presentation, natural history, and treatment efficacy.
- To highlight the potential for a unified disease spectrum between collagenous and lymphocytic colitis.
Main Methods:
- Review of existing literature on microscopic colitis.
- Analysis of histological findings and clinical presentation.
- Evaluation of randomized controlled trials for treatment effectiveness.
Main Results:
- Microscopic colitis presents with chronic watery diarrhea, normal endoscopic findings, and specific histological changes.
- The condition typically undergoes spontaneous remission and has a benign clinical course without increased colorectal cancer risk.
- Colloidal bismuth and budesonide are the only treatments proven effective in randomized controlled trials.
Conclusions:
- Microscopic colitis is likely a spectrum of a single disease, potentially triggered by luminal antigens.
- While generally benign, effective treatment options are limited, with budesonide and colloidal bismuth showing promise.