Microscopic colitis: Etiopathology, diagnosis, and rational management
- Department of Gastroenterology, Herlev Hospital, University of Copenhagen, Denmark
- Department of Gastroenterology, Hospital Universitari Mutua Terrassa, Spain
- Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas, Spain
- Department of Gastroenterology, Keio University School of Medicine, Japan
- Division of Gastroenterology and Hepatology, Mayo Clinic, United States
Figures
Figure 1
Geographic distribution of microscopic colitis in different parts of the world.
Most recent incidence rates (× 105 inhabitants per year) of both collagenous colitis (CC) and lymphocytic colitis (LC) from Europe and North America where population-based studies have been …
Figure 2
Main factors involved in the pathophysiology of microscopic colitis.
Figure 3
Histological findings of microscopic colitis.
(A) Typical colonic biopsy from a patient with collagenous colitis with a subepithelial collagenous band of more than 10 μM. The surface epithelium is flattened, and mucin depleted, and a mixed …
Figure 4
Proposed treatment algorithm for the clinical management of symptomatic microscopic colitis.
Immune checkpoint inhibitors (ICIs). *Loperamide or bismuth subsalicylate in mild cases, cholestyramine mainly if there is associated bile acid malabsorption. **Use the lowest effective dose as …
Tables
Table 1
Key histological findings in microscopic colitis: differences between collagenous and lymphocytic colitis.
| Parameter | Collagenous colitis | Lymphocytic colitis |
|---|---|---|
| Intraepithelial lymphocytes | Normal or increased number | >20 per 100 epithelial cells |
| Surface epithelium | Marked change (flattening, detachment) | Slight change (vacuolization, flattening, mucin depletion) |
| Subepithelial collagenous band | Thickening (≥10 μm) | Normal or slightly increased (<10 μm) |
| Inflammatory infiltrate in the lamina propria | Increased infiltrate (lymphocytes and plasma cells) with homogenous distribution throughout the colon | |
| Crypt architecture | Little or no distortion | |
| Inflammatory bowel disease-type focal changes | Occasional cryptitis and Paneth cell metaplasia | |
