Microscopic colitis: pathophysiology and clinical management

Stephan Miehlke, Bas Verhaegh, Gian Eugenio Tontini, Ahmed Madisch, Cord Langner, Andreas Münch

Research output: Contribution to journalReview articlepeer-review


Microscopic colitis is a chronic inflammatory disease of the colon that frequently causes chronic watery diarrhoea that might be accompanied by abdominal pain, nocturnal diarrhoea, urgency, and faecal incontinence. These symptoms lead to poor quality of life and increased health-care costs. Diagnosis relies on histological examination of multiple biopsy samples from the colonic mucosa, which often show no or only few abnormalities on endoscopy. Two major histological subtypes can be distinguished—collagenous colitis and lymphocytic colitis—but incomplete and variant forms with fewer characteristic features have been reported. Here we summarise the latest evidence on epidemiology, pathogenesis, and risk factors, and discuss established and novel therapeutic options for clinical remission. Finally, we propose an updated treatment algorithm. Further prospective studies are needed to clarify the natural history of microscopic colitis, supported by validated criteria for the assessment of disease activity.

Original languageEnglish
Pages (from-to)305-314
Number of pages10
JournalThe Lancet Gastroenterology and Hepatology
Issue number4
Publication statusPublished - Apr 1 2019

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology


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