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Management of microscopic colitis: challenges and solutions

Authors Shor J, Churrango G, Hosseini N, Marshall C

Received 17 September 2018

Accepted for publication 21 January 2019

Published 27 February 2019 Volume 2019:12 Pages 111—120


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Professor Andreas M. Kaiser

Julia Shor,1 Gustavo Churrango,1 Nooshin Hosseini,2 Christopher Marshall1

1Department of Gastroenterology, University of Massachusetts Medical School, Worcester, MA, USA; 2Department of Gastroenterology, Mount Sinai Hospital, New York, NY, USA

Abstract: 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.

Keywords: microscopic colitis, diarrhea, collagenous colitis, lymphocytic colitis, management, inflammatory colitis

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