Microscopic colitis: Etiopathology, diagnosis, and rational management

Abstract

Microscopic colitis is an inflammatory bowel disease divided into two subtypes: collagenous colitis and lymphocytic colitis. With an increasing incidence of microscopic colitis exceeding those of ulcerative and Crohn’s disease among elderly people in some countries, microscopic colitis is a debilitating life experience. Therefore, physicians should be familiar with its clinical features and management strategies because the disease deserves the same attention as the classical inflammatory bowel diseases. Here, state-of-the-art knowledge of microscopic colitis is provided from a global perspective with reference to etiopathology and how to establish the diagnosis with the overall aim to create awareness and improve rational management in clinical practice. The immune system and a dysregulated immune response seem to play a key role combined with risk factors (e.g. cigarette smoking) in genetically predisposed individuals. The symptoms are characterized by recurrent or chronic nonbloody, watery diarrhea, urgency, weight loss, and a female preponderance. As biomarkers are absent, the diagnosis relies on colonoscopy with a histological assessment of biopsy specimens from all parts of the colon. Although the disease is not associated with a risk of colorectal cancer, a recent nationwide, population-based cohort study found an increased risk of lymphoma and lung cancer. Budesonide is the first-line therapy for management, whereas immunomodulatory drugs (including biologics) and drugs with antidiarrheal properties may be indicated in those failing, dependent, or intolerant to budesonide. In microscopic colitis induced by checkpoint inhibitors, a drug class used increasingly for a wide range of malignancies, a more aggressive therapeutic approach with biologics introduced early seems reasonable. However, particular attention needs to be drawn to the existence of incomplete forms of microscopic colitis with the risk of being overlooked in routine clinical settings.

Mikroskopinio Kolito Gydymo Galimybės Klinikinėje Praktikoje

“…Remisijos indukcija dažniausiai būna gerai toleruojama pacientų, o komplikacijų, susijusių su ilgalaikiu gliukortikosteroidų vartojimu (osteopenija/osteoporozė, cukrinis diabetas, arterinė hipertenzija, glaukoma, katarakta) pasitaiko retai dėl vaisto farmakologinių savybių [22]. Nors pradinio gydymo metu didelė pacientų dalis pasiekia klinikinę ir histologinę remisiją, tačiau MK yra itin būdingi ligos atkryčiai [23]. Kai atkryčiai pasireiškia dažnai, remisijos palaikymui galima skirti ilgalaikį gydymą mažomis budezonido dozėmis [3].…”

Reduced Intake of Dietary Tryptophan Improves Beneficial Action of Budesonide in Patients with Lymphocytic Colitis and Mood Disorders

“…Other corticosteroids, thiopurines and biologicals may be used in selected patients who fail to respond to budesonide. Mesalazine, antibiotics and probiotics are not recommended [ 13 , 14 ].…”

Discovery of Novel Sesquiterpene Lactone Derivatives as Potent PKM2 Activators for the Treatment of Ulcerative Colitis

“…Ulcerative colitis (UC), together with Crohn’s disease (CD) belonging to the category of inflammatory bowel disease (IBD), is a chronic and relapsing inflammatory disorder . The symptoms and signs of UC include bloody diarrhea, abdominal pain, urgency, tenesmus, and rectal bleeding. , More seriously, long-term recurrent inflammatory injury frequently progresses to colitis-associated colon cancer, resulting in serious threats to patients, even endangering their lives . Till now, there are only a few drugs being used in clinics for the treatment of UC, which are restricted to immunosuppressive agents, glucocorticoids, and aminosalicylic acids .…”