Microscopic colitis: A literature review

Clara, Ana; Magnago, Flávia Drago; Ferreira, Juliana Neves; Grillo, Thaís Gagno

doi:10.1590/1806-9282.62.09.895

Cited by 6 publications

(5 citation statements)

References 38 publications

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“…This has been shown to correlate significantly with an increase in HRQOL and consequently has been widely utilized. It is yet unclear whether histologic remission should be a goal that drives therapy 36,37. Given that, to date, no biomarker has been identified to assess the severity of disease, defining disease activity by clinical variables is crucial.…”

Section: Managementmentioning

confidence: 99%

<p>Management of microscopic colitis: challenges and solutions</p>

Shor¹,

Churrango²,

Hosseini³

et al. 2019

CEG

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Microscopic colitis (MC) is a chronic inflammatory bowel disease characterized by nonbloody diarrhea in the setting of normal appearing colonic mucosa. MC has two main subtypes based on histopathologic features, collagenous colitis and lymphocytic colitis. Management of both subtypes is the same, with treatment goal of reducing the number of bowel movements and improving consistency. First-line treatment involves counseling the patient about decreasing their risk factors, like discontinuing smoking and avoiding medications with suspected association such as NSAIDs, proton pump inhibitor, ranitidine, and sertraline. Starting loperamide for immediate symptomatic relief is used as an adjunct to therapy with glucocorticoids. Budesonide is considered first-line treatment for MC given its favorable side effect profile and good efficacy, though relapse rates are high. Systemic glucocorticoids should be reserved to patients unable to take budesonide. In glucocorticoid refractory disease, medications that have been tried include cholestyramine, bismuth salicylate, antibiotics, probiotics, aminosalicylates, immunomodulators, and anti-tumor necrosis factor-alpha inhibitors. More research is needed for the creation of a systematic stepwise approach for relapsing and refractory disease.

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Section: Managementmentioning

confidence: 99%

<p>Management of microscopic colitis: challenges and solutions</p>

Shor¹,

Churrango²,

Hosseini³

et al. 2019

CEG

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“…The elderly group (>60 years) was more susceptible to microscopic colitis. A previous study found that women are 20 times more prone to collagen colitis than men, whereas, in lymphocytic colitis, there was no significant difference between men and women [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

High levels of fecal calprotectin and C-reactive protein in patients with colitis

et al. 2023

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Inflammatory bowel disease (IBD) with a poor prognosis may be due to persistent colitis. According to the latest guidelines, monitoring has become a part of the treatment process for colitis. Adequate monitoring of the patient's condition is necessary to determine the course of the disease to prevent the worsening of the condition and suppress the subclinical inflammatory process. This analytical study with a cross-sectional design was conducted to evaluate the activity of colitis using the results of C-reactive protein (CRP) and fecal calprotectin (FC) assays. FC levels were analyzed by ELISA, while CRP levels were analyzed using Siemens Flex particle-enhanced turbidimetric immunoassay. In 30 subjects with endoscopy and biopsy of colitis, 16 men and 14 women had a median age of 52.5 (18–70) years. The median FC value increased by 67 (7.3–722 g/g) and was positive (≥50 g/g) in 20 subjects (66.7%), and the mean CRP value was 13.64 mg/L, positive (10–15 mg/L) in 13 subjects (43.33%), and negative (<10 mg/L) in 17 subjects (56.67%). This study demonstrated that FC had a significant relationship with CRP (r=0.57; p<0.001) in patients with colitis. Assessing the levels of FC and CRP among patients with colitis can be useful to assess the worsening of symptoms early and reduce mortality and morbidity.

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Section: Discussionmentioning

confidence: 99%

“…Therefore, the results should be interpreted with caution until greater data are published in the literature. We also recommend future studies that explore whether histological remission should be an outcome to drive therapy, as this is currently uncertain [34][35][36] and subsequently not recommended by the European Guidelines. 2 The probiotic containing eight bacterial strains including Bifidobacterium, Lactobacillus and Streptococcus and the probiotic AB-CAP-10 ranked second for inducing and maintaining clinical remission, respectively.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of medical therapies in microscopic colitis: a systematic review and network meta-analysis

Kumar

Hiner

Brookes

et al. 2023

Therap Adv Gastroenterol

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Background: The mainstay of treatment for microscopic colitis (MC) is budesonide. However, the optimal formulation and dosage of budesonide to induce and maintain remission has not yet been clearly demonstrated. Objectives: To compare the data for efficacy and safety of treatments to induce and maintain remission for MC. Design: We conducted a meta-analysis of randomised controlled trials (RCTs) comparing treatment with each other or placebo for induction and maintenance of clinical and histological remission in MC. Data sources and methods: We searched MEDLINE (1946 to May 2021), EMBASE and EMBASE Classis (1947 to May 2021), the Cochrane central register of controlled trials (Issue 2, May 2021) and conference proceedings between 2006 and 2020. Results were reported as pooled relative risks (RRs) with 95% confidence intervals (CIs) to summarise the effect of each comparison tested, with treatments ranked according to p score. Results: We identified 15 RCTs in total for the treatment of MC. Entocort 9 mg ranked first for clinical (RR: 4.89, CI: 2.43–9.83; p score: 0.86) and histological (RR: 13.39, CI: 1.92–93.44; p score 0.94) induction of remission, whilst VSL#3 ranked second for clinical induction (RR: 5.30, CI: 0.68–41.39; p score 0.81). Budenofalk 6 mg/3 mg alternate day dosing ranked first for clinical maintenance of remission (RR: 3.68, CI: 0.08–159.92, p-score 0.65). Entocort and Budenofalk were associated with the greatest adverse events for induction and maintenance of clinical remission, respectively, although the overall withdrawal numbers for treatment versus placebo groups were 10.9% (22/201) and 10.5% (20/190), respectively. Conclusion: Entocort 9 mg/day ranked first among the treatment options in inducing remission and Budenofalk 6 mg/3 mg alternate day dosing for maintaining remission in the treatment of MC. Moving forward, mechanistic studies exploring the differences between Entocort and Budenofalk would be valuable whilst future RCT studies are needed in non-corticosteroidal maintenance, particularly looking into immunomodulators, biologics and probiotics.

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Microscopic colitis: A literature review

Cited by 6 publications

References 38 publications

<p>Management of microscopic colitis: challenges and solutions</p>

<p>Management of microscopic colitis: challenges and solutions</p>

High levels of fecal calprotectin and C-reactive protein in patients with colitis

Efficacy and safety of medical therapies in microscopic colitis: a systematic review and network meta-analysis

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