title: Current concepts on microscopic colitis: evidence-based statements and recommendations of the Spanish Microscopic Colitis Group.
abstract: BACKGROUND
  Microscopic colitis (MC) is an underdiagnosed inflammatory bowel disease.
  
  
  OBJECTIVE
  To develop an evidence-based clinical practice guide on MC current concepts.
  
  
  METHODS
  Literature search was done on the Cochrane Library, EMBASE and MEDLINE electronic databases, which were consulted covering the period up until March 2015. Work groups were selected for each of the reviewed topics, with the purpose of drafting the initial statements and recommendations. They subsequently underwent a voting process based on the Delphi method. Each statement/recommendation was accompanied by the result of the vote the level of evidence, and discussion of the corresponding evidence. The grade of recommendation (GR) using the GRADE approach was established for diagnosis and treatment recommendations.
  
  
  RESULTS
  Some key statements and recommendations are: advancing age increases the risk of developing MC, mainly in females. The symptoms of MC and IBS-D may be similar. If MC is suspected, colonoscopy taking biopsies is mandatory. Treatment with oral budesonide is recommended to induce clinical remission in patients with MC. Oral mesalazine is not recommended in patients with collagenous colitis for the induction of clinical remission. The use of anti-TNF-alpha drugs (infliximab, adalimumab) is recommended for the induction of remission in severe cases of MC that fail to respond to corticosteroids or immunomodulators, as an alternative to colectomy.
  
  
  CONCLUSIONS
  This is the first consensus paper on MC based on GRADE methodology. This initiative may help physicians involved in care of these patients in taking decisions based on evidence.
authors.affiliation: Hospital Universitari Mutua Terrassa, Barcelona, Spain.|Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Fernández-Bañares
authors.affiliation: Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.|Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.
authors.forename: M J
authors.initials: MJ
authors.lastname: Casanova
authors.affiliation: Hospital San Jorge, Huesca, Spain.
authors.forename: Y
authors.initials: Y
authors.lastname: Arguedas
authors.affiliation: Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.|Hospital La Fe, Valencia, Spain.
authors.forename: B
authors.initials: B
authors.lastname: Beltrán
authors.affiliation: Hospital Doctor Josep Trueta, Girona, Spain.
authors.forename: D
authors.initials: D
authors.lastname: Busquets
authors.affiliation: Hospital Universitario Fundación Alcorcón, Madrid, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Fernández
authors.affiliation: Hospital Clínico Universitario, Valladolid, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Fernández-Salazar
authors.affiliation: Hospital Sant Pau, Barcelona, Spain.
authors.forename: E
authors.initials: E
authors.lastname: García-Planella
authors.affiliation: Hospital Vall d'Hebron, Barcelona, Spain.
authors.forename: D
authors.initials: D
authors.lastname: Guagnozzi
authors.affiliation: Hospital General de Tomelloso, Ciudad Real, Spain.
authors.forename: A J
authors.initials: AJ
authors.lastname: Lucendo
authors.affiliation: Hospital Infanta Sofía, San Sebastián de los Reyes, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Manceñido
authors.affiliation: Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Marín-Jiménez
authors.affiliation: Hospital San Jorge, Huesca, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Montoro
authors.affiliation: Consorci Sanitari, Terrassa, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Piqueras
authors.affiliation: Hospital Vall d'Hebron, Barcelona, Spain.
authors.forename: V
authors.initials: V
authors.lastname: Robles
authors.affiliation: Hospital de Bellvitge, L'Hospitalet de Llobregat, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Ruiz-Cerulla
authors.affiliation: Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.|Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.
authors.forename: J P
authors.identifier: http://orcid.org/0000-0003-2090-3445
authors.initials: JP
authors.lastname: Gisbert
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000367:Age Factors; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001706:Biopsy; D019819:Budesonide / Q000627:therapeutic use; D046728:Colitis, Microscopic / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology*; D003113:Colonoscopy; D006801:Humans; D000069285:Infliximab / Q000627:therapeutic use; D012737:Sex Factors; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D014409:Tumor Necrosis Factor-alpha; D019819:Budesonide; D000069285:Infliximab; D000068879:Adalimumab