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Microscopic colitis: diagnosis and management
  1. Tristan Townsend1,
  2. Fiona Campbell2,
  3. Paul O’Toole1,
  4. Chris Probert3
  1. 1 Department of Gastroenterology, Royal Liverpool University Hospital, Liverpool, UK
  2. 2 Department of Pathology, Royal Liverpool University Hospital, Liverpool, UK
  3. 3 Department of Cellular and Molecular Physiology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
  1. Correspondence to Professor Chris Probert, Gastroenterology, University of Liverpool, Liverpool L69 3GE, UK; Chris.Probert{at}


Microscopic colitis (MC) is a common cause of chronic, non-bloody, watery diarrhoea in older patients. The diagnosis depends on characteristic histological findings. Bile acid malabsorption and autoimmune conditions, including coeliac disease, are more frequently found in patients with MC, but colorectal neoplasia and mortality are not increased. Non-steroidal anti-inflammatory drugs, proton-pump inhibitors, selective serotonin reuptake inhibitors and smoking tobacco confer an increased risk of developing MC. Although a so-called benign disease, which rarely causes serious complications, it does have an impact on the quality of life. Several treatment options exist, but budesonide is the only treatment proven in randomised-controlled trials to be effective and safe for induction and maintenance of remission. This article provides a practical overview for the gastroenterologist looking after patients with MC.

  • microscopic colitis
  • lymphocytic colitis
  • collagenous colitis
  • chronic diarrhoea

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  • Contributors TT wrote and revised the manuscript. CP reviewed and revised the manuscript. FC reviewed and revised the manuscript and provided appropriate histology images and advice upon their interpretation. PO reviewed and revised the manuscript and provided appropriate endoscopic images and advice upon their interpretation.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests CP: speaker fees from AbbVie, Avantis, Dr Falk Pharma, Ferring, Hospira, Janssen, Merck, Shire and Takeda; payment for advisory board attendance from Avantis, Dr Falk Pharma, Ferring, Janssen, Hospira (Pfizer), Merck, Napp and Takeda; and support for attendance to other meetings from Avantis, Dr Falk Pharma, Merck, Shire, Hospira, Takeda and Vifor.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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