Systematic review: microscopic colitis.
BACKGROUND
Collagenous and lymphocytic colitis are fairly common causes of chronic non-bloody diarrhoea, especially in elderly female.


OBJECTIVE
To present a systematic review of microscopic colitis.


METHODS
A PubMed search using the MeSH terms microscopic colitis, collagenous colitis, lymphocytic colitis and chronic diarrhoea was performed.


RESULTS
Annual incidence of each disorder is 4-6/100,000 inhabitants. The aetiology is unknown. Clinical characteristics are well described and there is an association with autoimmune diseases. Budesonide is the best-documented short-term treatment of collagenous colitis. In meta-analysis pooled odds ratio for clinical response after 6-8 weeks of treatment was 12.3 (95% CI: 5.5-27.5) in comparison with placebo. The evidence for bismuth subsalicylate is weaker and the effectiveness of other alternatives such as loperamide, cholestyramine, aminosalicylates, probiotics, or Boswellia serrata extract is unknown. Although unproven, in unresponsive severe disease azathioprine or methotrexate may be tried. No controlled trials have been carried out in lymphocytic colitis. The long-term prognosis of microscopic colitis is good, serious complications are rare and there is no increased mortality.


CONCLUSIONS
Clinical and epidemiological aspects of microscopic colitis are well described. Budesonide is the best-documented short-term therapy in collagenous colitis, but the optimal long-term strategy needs further study. Controlled treatment data of lymphocytic colitis are awaited for.
Nyhlin
N
N
Department of Medicine, Division of Gastroenterology, Orebro University Hospital, Orebro, Sweden.
Bohr
J
J
Eriksson
S
S
Tysk
C
C
D000368:Aged; D000930:Antidiarrheals / Q000627:therapeutic use*; D019819:Budesonide / Q000627:therapeutic use*; D046728:Colitis, Microscopic / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology; D005260:Female; D006801:Humans; D015994:Incidence; D008875:Middle Aged
D000930:Antidiarrheals; D019819:Budesonide