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Microscopic colitis in children: A single-center experience and systematic review
Laura M Hernández Díaz1, Bashar Hasan2, Alaa Almallouhi3
1Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Objectives:
Microscopic colitis (MC) is an inflammatory disease of the large intestine characterized by chronic diarrhea, normal-appearing colonic mucosa on endoscopy, and abnormal inflammatory histopathology. While it is a common cause of chronic diarrhea in adults, MC is infrequently reported in children, and data on its presentation, treatment, and outcomes remain limited. This study aimed to analyze single-center experience and conduct a literature review on pediatric MC.
Methods:
A retrospective review of the Mayo Clinic electronic health records from 2013 to 2024 was performed. Children (≤18 years) diagnosed with MC were included. Demographics, clinical presentation, treatment, and outcomes were collected. A systematic review of pediatric MC literature was completed.
Results:
MC was diagnosed in 42 children (median age 12.5 years; Q1-Q3 7.25-14.75), with 28 (67%) females. Systematic review identified 29 studies with 258 children with MC (mean age 10 years, standard deviation [SD] 4.9). At Mayo Clinic, treatment varied among providers, and budesonide as monotherapy or in combination was most effective. In the literature, the most commonly used treatments included 5-aminosalicylates (5-ASA, 36%) and budesonide (31.5%). Combination therapy with budesonide plus a biologic or mesalamine appeared to be the most effective therapy, followed by budesonide monotherapy and corticosteroids. Mucosal remission rate was highest with corticosteroids, followed by budesonide. Mean recurrence rate across all treatments was 69%. Biologics (vedolizumab, infliximab) and bismuth showed the lowest recurrence rates.
Conclusion:
Budesonide, either alone or in combination, appears to be most commonly used and effective in treating pediatric MC, but recurrence rates remain high after therapy discontinuation.
Insights
Budesonide is effective for pediatric microscopic colitis (MC), often used alone or combined. However, high recurrence rates persist after treatment cessation in children with this inflammatory bowel disease.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease
- Histopathology
Background:
- Microscopic colitis (MC) is a significant cause of chronic diarrhea in adults, yet its occurrence and characteristics in children are less understood.
- Limited data exist regarding the presentation, treatment efficacy, and long-term outcomes of pediatric MC.
Purpose of the Study:
- To analyze a single-center's experience with pediatric microscopic colitis.
- To conduct a systematic literature review to consolidate existing knowledge on pediatric MC.
Main Methods:
- Retrospective analysis of electronic health records for pediatric patients diagnosed with MC.
- Systematic review of published literature on pediatric microscopic colitis cases.
Main Results:
- Budesonide, used as monotherapy or in combination, demonstrated the highest effectiveness in the single-center cohort.
- Across the literature, budesonide and 5-aminosalicylates were common treatments, with combination therapies (budesonide + biologic/mesalamine) showing superior efficacy.
- While corticosteroids yielded the highest remission rates, budesonide monotherapy was also effective. Recurrence rates were high (69%) overall, with biologics and bismuth showing the lowest recurrence.
Conclusions:
- Budesonide, alone or in combination, is a primary and effective treatment for pediatric MC.
- High recurrence rates following treatment discontinuation highlight the need for ongoing management strategies.
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