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Current Approach to the Evaluation and Management of Microscopic Colitis

  • Thomas G. Cotter
  • Darrell S. PardiEmail author
Large Intestine (B Cash, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Large Intestine

Abstract

Purpose of Review

Microscopic colitis is a common cause of chronic watery diarrhea, particularly in the elderly. The accompanying symptoms, which include abdominal pain and fatigue, can markedly impair patients’ quality of life. Diagnosis is based upon characteristic histologic findings of the colonic mucosa. This review focuses on the current approach to evaluation and management of patients with microscopic colitis.

Recent Findings

Although the incidence of microscopic colitis has been increasing over time, recent epidemiological studies show stabilization at 21.0–24.7 cases per 100,000 person-years. Recent research has further expanded our knowledge of the underlying pathophysiology and emphasized the entity of drug-induced microscopic colitis and the association with celiac disease. Two recent randomized studies have confirmed the effectiveness of oral budesonide for both induction and maintenance treatment of microscopic colitis and is now endorsed by the American Gastroenterological Association as first-line treatment.

Summary

The incidence of microscopic colitis has stabilized at just over 20 cases per 100,000 person-years. Celiac disease and drug-induced microscopic colitis should be considered in all patients diagnosed with microscopic colitis. There are a number of treatments available for patients with microscopic colitis; however, budesonide is the only option well studied in controlled trials and is effective for both induction and maintenance treatment.

Keywords

Microscopic colitis Microscopic colitis treatment Microscopic colitis management Large intestine 

Notes

Compliance with Ethical Standards

Conflict of Interest

Thomas Cotter declares no conflict of interest. Darrell Pardi has served as a consultant to Salix, who markets Uceris.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: •Of importance, ••Of major importance

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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.Department of Internal MedicineMayo ClinicRochesterUSA
  2. 2.Division of Gastroenterology and HepatologyMayo ClinicRochesterUSA

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