Key Points
- Microscopic colitis is characterized by chronic watery diarrhea caused by inflammation in the colon and diagnosed by colonic biopsy.
- The reported prevalence of microscopic colitis ranges from 48–219 per 100,000.
- There is a predilection for those ≥60 years of age.
- There are 2 subtypes: lymphocytic colitis and collagenous colitis. There is a female predominance in the latter.
- Microscopic colitis is not associated with increased mortality.
- The goal of medical therapy reflected in these recommendations is to relieve symptoms and improve quality of life while minimizing drug-related adverse effects.
Treatment
Summary of Recommendations of the AGA Guideline on the Medical Management of Microscopic Colitis
| Recommendation | Strength of recommendation | Quality of evidence |
|---|---|---|
| In patients with symptomatic microscopic colitis, the AGA recommends treatment with budesonide over no treatment for the induction of clinical remission. | Strong | Moderate |
| In patients with symptomatic microscopic colitis, the AGA recommends treatment with budesonide over mesalamine for the induction of clinical remission. | Strong | High |
| In patients with symptomatic microscopic colitis in whom budesonide therapy is not feasible, the AGA suggests treatment with mesalamine over no treatment for the induction of clinical remission. | Conditional | Moderate |
| In patients with symptomatic microscopic colitis in whom budesonide therapy is not feasible, the AGA suggests treatment with bismuth salicylate over no treatment for the induction of clinical remission. | Conditional | Low |
| In patients with symptomatic microscopic colitis in whom budesonide therapy is not feasible, the AGA suggests treatment with prednisolone (or prednisone) over no treatment for the induction of clinical remission. | Conditional | Very Low |
| In patients with symptomatic microscopic colitis, the AGA suggests against combination therapy with cholestyramine and mesalamine over mesalamine alone for the induction of clinical remission. | Conditional | Low |
| In patients with symptomatic microscopic colitis, the AGA suggests against treatment with Boswellia serrata over no treatment for the induction of clinical remission. | Conditional | Low |
| In patients with symptomatic microscopic colitis, the AGA suggests against treatment with probiotics over no treatment for the induction of clinical remission. | Conditional | Low |
| For patients with recurrence of symptoms following discontinuation of induction therapy for microscopic colitis, the AGA recommends budesonide for maintenance of clinical remission. | Strong | Moderate |
Management Of Microscopic Colitis
Clinical Decision Support Tool
