Current concepts on microscopic colitis: evidence‐based statements and recommendations of the Spanish Microscopic Colitis Group

Abstract

Summary Background Microscopic colitis (MC) is an underdiagnosed inflammatory bowel disease. Aim To develop an evidence‐based clinical practice guide on MC current concepts. Methods Literature search was done on the Cochrane Library, EMBASE and MEDLINE electronic databases, which were consulted covering the period up until March 2015. Work groups were selected for each of the reviewed topics, with the purpose of drafting the initial statements and recommendations. They subsequently underwent a voting process based on the Delphi method. Each statement/recommendation was accompanied by the result of the vote the level of evidence, and discussion of the corresponding evidence. The grade of recommendation (GR) using the GRADE approach was established for diagnosis and treatment recommendations. Results Some key statements and recommendations are: advancing age increases the risk of developing MC, mainly in females. The symptoms of MC and IBS‐D may be similar. If MC is suspected, colonoscopy taking biopsies is mandatory. Treatment with oral budesonide is recommended to induce clinical remission in patients with MC. Oral mesalazine is not recommended in patients with collagenous colitis for the induction of clinical remission. The use of anti‐TNF‐alpha drugs (infliximab, adalimumab) is recommended for the induction of remission in severe cases of MC that fail to respond to corticosteroids or immunomodulators, as an alternative to colectomy. Conclusions This is the first consensus paper on MC based on GRADE methodology. This initiative may help physicians involved in care of these patients in taking decisions based on evidence.

Letter: the definition of budesonide dependence in microscopic colitis

“…In fact, it is well known that budesonide is highly effective in inducing clinical remission in collagenous colitis, but the clinical relapse rate after budesonide discontinuation is very high (around 80%). [2][3][4] In view of the high relapse rate after withdrawal, it has been proposed to use low doses of budesonide to maintain remission. 4 This strategy has shown to be highly effective, maintaining clinical remission in 65%-80% of patients, with budesonide doses ranging from 4.5 to 6 mg/d for 6-12 months.…”

Macroscopic Findings in Microscopic Colitis: Two Case Reports and a Review of Literature

“…Microscopic colitis is diagnosed on the basis of characteristic histologic findings, adequate endoscopic sampling is key. It is recommended to take at least two biopsies per segment, to ensure a high degree of likelihood of detect findings suggestive of CC or LC [20]. Key diagnostic components for the diagnosis of MC is defined as subepithelial collagenous band >10μm in thickness for CC and increase of intraepithelial lymphocytes (>20 per 100 epithelial cells) for LC [21].…”

Th1 Pathway: The Missing Link Between Inflammatory Bowel Disease and Microscopic Colitis?

“…Its two principal manifestations are differentiated by their histopathological features: collagenous colitis (CC) and lymphocytic colitis (LC). Advancing age, female sex, smoking, and the use of drugs such as proton pump inhibitors and nonsteroidal antiinflammatory drugs are recognized risk factors for the development of MC [1]. Although studies of its natural history and long-term outcome are limited and scarce, it is generally considered a benign condition, and for all practical purposes, MC mostly differs from conventional inflammatory bowel disease (IBD) (i.e., Crohn's disease and ulcerative colitis).…”