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Published on: October 16, 2013
Systematic review: microscopic colitis
1Department of Medicine, Division of Gastroenterology, Orebro University Hospital, Orebro, Sweden.
Background:
Collagenous and lymphocytic colitis are fairly common causes of chronic non-bloody diarrhoea, especially in elderly female.
Aim:
To present a systematic review of microscopic colitis.
Methods:
A PubMed search using the MeSH terms microscopic colitis, collagenous colitis, lymphocytic colitis and chronic diarrhoea was performed.
Results:
Annual incidence of each disorder is 4-6/100,000 inhabitants. The aetiology is unknown. Clinical characteristics are well described and there is an association with autoimmune diseases. Budesonide is the best-documented short-term treatment of collagenous colitis. In meta-analysis pooled odds ratio for clinical response after 6-8 weeks of treatment was 12.3 (95% CI: 5.5-27.5) in comparison with placebo. The evidence for bismuth subsalicylate is weaker and the effectiveness of other alternatives such as loperamide, cholestyramine, aminosalicylates, probiotics, or Boswellia serrata extract is unknown. Although unproven, in unresponsive severe disease azathioprine or methotrexate may be tried. No controlled trials have been carried out in lymphocytic colitis. The long-term prognosis of microscopic colitis is good, serious complications are rare and there is no increased mortality.
Conclusions:
Clinical and epidemiological aspects of microscopic colitis are well described. Budesonide is the best-documented short-term therapy in collagenous colitis, but the optimal long-term strategy needs further study. Controlled treatment data of lymphocytic colitis are awaited for.
Insights
Microscopic colitis, including collagenous and lymphocytic types, causes chronic diarrhea. Budesonide shows promise for collagenous colitis short-term treatment, but more research is needed for long-term strategies and lymphocytic colitis therapies.
Area of Science:
- Gastroenterology
- Internal Medicine
- Pathology
Background:
- Microscopic colitis, encompassing collagenous colitis and lymphocytic colitis, is a frequent cause of chronic non-bloody diarrhea, particularly in elderly women.
- The etiology of microscopic colitis remains unknown, though an association with autoimmune diseases is observed.
Purpose of the Study:
- To conduct a systematic review of microscopic colitis.
- To synthesize current knowledge on the clinical and epidemiological aspects of microscopic colitis.
Main Methods:
- A comprehensive literature search was performed using PubMed.
- Keywords included "microscopic colitis," "collagenous colitis," "lymphocytic colitis," and "chronic diarrhea."
Main Results:
- The annual incidence for both collagenous and lymphocytic colitis is 4-6 per 100,000 inhabitants.
- Budesonide is the most supported short-term treatment for collagenous colitis, with a pooled odds ratio for clinical response of 12.3 (95% CI: 5.5-27.5) compared to placebo.
- Evidence for other treatments is limited, and controlled trials for lymphocytic colitis are lacking. Long-term prognosis is generally good with rare complications and no increased mortality.
Conclusions:
- Clinical and epidemiological features of microscopic colitis are well-established.
- Budesonide is effective for short-term collagenous colitis management, but optimal long-term treatment requires further investigation.
- Controlled treatment data for lymphocytic colitis is anticipated.
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