Microscopic colitis: a population‐based case series over a 9‐year period in Northern Ireland

Moore, M. A. S.; Coleman, Helen; Allen, Patrick B.; Loughrey, Maurice B.

doi:10.1111/codi.14247

Cited by 6 publications

(15 citation statements)

References 38 publications

(54 reference statements)

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“…It is of note that in a considerable percentage of MC cases, a range of endoscopic abnormalities was reported, such as patchy reddening/ inflammation, alteration of the vascular mucosal pattern, mosaic pattern, diffuse mucosal cloudiness, mucosal nodularity or mucosal defects. [9][10][11][12] The etiology of MC remains unsettled.…”

Section: Discussionmentioning

confidence: 99%

Colitis nucleomigrans: The third type of microscopic colitis (part 1)

Tachibana

Hanaoka

Watanabe

et al. 2020

Pathology International

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Microscopic colitis (MC), encompassing collagenous colitis and lymphocytic colitis, is featured by chronic diarrhea, normal-looking endoscopic findings and unique microscopic appearance. After reviewing biopsied nonspecific colitis, we propose the third type of MC: colitis nucleomigrans (CN). Histopathological criteria of CN included: (i) chained nuclear migration to the middle part of the surface-lining columnar epithelium; (ii) apoptotic nuclear debris scattered below the nuclei; and (iii) mild/moderate chronic inflammation in the lamina propria. Thirty-three patients (M:F = 20:13; median age 63 years, range 17-88) fulfilled our criteria. Seven cases demonstrated MC-like clinical/endoscopic features. Mucosal reddening with or without erosion/aphtha was endoscopically observed in the remaining 26 cases with inflammatory bowel disease (IBD)-like features: occult/gross hematochezia seen in 19, abdominal pain in two and mucin secretion in two. Cleaved caspase-3-immunoreactive apoptotic debris appeared more frequently in IBD-like CN than in MC-like CN, while CD8-positive intraepithelial lymphocytes comparably appeared in both. Proton pump inhibitors (PPIs) were administered in five (71%) cases with MC-like features, and in three diarrhea improved after drug cessation. In IBD-like CN cases, eight (31%) received PPIs. Four patients received chemotherapy against malignancies. Four patients associated immune-related disorders. Microscopic appearance of CN also appeared in a remission state of ulcerative colitis (12/20 lesions).

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Section: Discussionmentioning

confidence: 99%

Colitis nucleomigrans: The third type of microscopic colitis (part 1)

Tachibana

Hanaoka

Watanabe

et al. 2020

Pathology International

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“…An overall pooled incidence rate of 11.4 (95% CI: 9.2–13.6, I 2 = 99.72%) cases of MC per 100,000 person‐years was calculated based on studies providing population‐based data 10–31 . Several studies from North America 20 , 27 and Europe 14,16–18,25,26,29 reported variations in incidence rates over a 10‐years‐time period in the same region. They all showed an increasing incidence in the early years, which has reached a plateau 32 .…”

Section: Methodsmentioning

confidence: 99%

“…The pooled incidence rate for CC 10 , 11 , 13–24 , 26–31 , 33–36 was 4.9 (95% CI: 4.2–5.7, I 2 = 98.3%) cases per 100,000 person‐years. The pooled LC incidence rate was 5.0 (95% CI: 4.0–6.1, I 2 98.75%) cases per 100,000 person‐years 10–31 . Geographic variations in the incidence of MC have been reported; however, the limited number of studies from Southern Europe compared to Northern Europe and the lack of direct comparative studies from different countries for the same time period does hinder firm conclusions on this matter.…”

Section: Methodsmentioning

confidence: 99%

European guidelines on microscopic colitis: United European Gastroenterology and European Microscopic Colitis Group statements and recommendations

et al. 2021

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Introduction Microscopic colitis is a chronic inflammatory bowel disease characterised by normal or almost normal endoscopic appearance of the colon, chronic watery, non-bloody diarrhoea and distinct histological abnormalities, which identify three histological subtypes, the collagenous colitis, the lymphocytic colitis and the incomplete microscopic colitis. With ongoing uncertainties and new developments in the clinical management of microscopic colitis, there is a need for evidence-based guidelines to improve the medical care of patients suffering from this disorder. Methods Guidelines were developed by members from the European Microscopic Colitis Group and United European Gastroenterology in accordance with the Appraisal of Guidelines for Research and Evaluation II instrument. Following a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation methodology was used to assess the certainty of the evidence. Statements and recommendations were developed by working groups consisting of gastroenterologists, pathologists and basic scientists, and voted upon using the Delphi method. Results These guidelines provide information on epidemiology and risk factors of microscopic colitis, as well as evidence-based statements and recommendations on diagnostic criteria and treatment options, including oral budesonide, bile acid binders, immunomodulators and biologics. Recommendations on the clinical management of microscopic colitis are provided based on evidence, expert opinion and best clinical practice. Conclusion These guidelines may support clinicians worldwide to improve the clinical management of patients with microscopic colitis.

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“…We recommend that colonoscopy, rather than flexible sigmoidoscopy, be routinely performed if MC is suspected as histologic changes can be patchy in distribution, and inflammatory severity is greatest in the more proximal colon. Flexible sigmoidoscopy, however, can diagnose >90% of MC 29,30. Classic histologic features of LC include >20 intraepithelial lymphocytes per 100 epithelial cells.…”

Section: General Overviewmentioning

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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Microscopic colitis: a population‐based case series over a 9‐year period in Northern Ireland

Cited by 6 publications

References 38 publications

Colitis nucleomigrans: The third type of microscopic colitis (part 1)

Colitis nucleomigrans: The third type of microscopic colitis (part 1)

European guidelines on microscopic colitis: United European Gastroenterology and European Microscopic Colitis Group statements and recommendations

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

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