Microscopic colitis in older adults: impact, diagnosis, and management

DIAGNOSIS AND TREATMENT OF MICROSCOPIC COLITIS: POSITION PAPER ON BEHALF OF THE BRAZILIAN FEDERATION OF GASTROENTEROLOGY

BACKGROUND

Microscopic colitis (MC) is a chronic inflammatory condition of the colon, primarily characterized by watery diarrhea, with normal or near-normal endoscopic findings. It encompasses two main subtypes: lymphocytic colitis and collagenous colitis.

OBJECTIVE

This position paper from the Brazilian Federation of Gastroenterology aims to review current evidence on the diagnosis and management of MC in Brazil, emphasizing the need for standardization across the country's healthcare systems.

METHODS

A comprehensive review of the latest scientific literature, clinical guidelines, and consensus statements was performed, focusing on randomized clinical trials, meta-analyses, and cohort studies. The evidence was analyzed by a panel of gastroenterologists and pathologists specializing in MC. The recommendations were based on the consensus of the group, approved by the majority of the panel members.

RESULTS

Histological examination with biopsies from multiple segments of the colon remains essential for the accurate diagnosis of MC, as endoscopic findings are often non-specific. Budesonide is the first-line treatment for inducing remission in most patients. However, alternatives such as immunosuppressants and biologics are available for those who are refractory to or intolerant of budesonide. Non-pharmacological interventions, including dietary and lifestyle modifications, can complement medical treatment. The need for long-term follow-up is highlighted due to the high recurrence rates and the impact of MC on the quality of life.

CONCLUSION

Standardizing the diagnosis and treatment of MC in Brazil is crucial, given the significant regional disparities in healthcare access. This position paper provides evidence-based recommendations to optimize care and improve patient outcomes across diverse clinical settings in Brazil. Further research is needed to address the gaps in understanding the epidemiology and management of MC in underserved regions.

WARNING TO DELAY IN DIAGNOSING MICROSCOPIC COLITIS IN OLDER ADULTS. A SERIES OF CASES

BACKGROUND

Microscopic colitis (MC) is a chronic inflammatory bowel disease causing non-bloody diarrhea, and several cases are undiagnosed as a hidden cause of chronic diarrhea.

OBJECTIVE

We aimed to report the symptoms, delay diagnosis and the treatment of MC in a case series.

METHODS

All patients were treated at a Gastroenterology reference office from May 2022 to June 2023. Personal history including preexisting disorders, use of medications and smoking habits were collected. The delay between the onset of symptoms and the correct diagnosis was informed. All patients consented to use budesonide MMX (Corament®) off label.

RESULTS

During the study period, six Caucasoid patients were diagnosed with MC, five females and one male, between the ages of 65 and 74. All patients had comorbities and were taking multiple prescription drugs. Laboratory findings showed negative serology for celiac disease for all patients, normal levels of albumin and vitamin B12. The delay between the symptoms and the MC diagnosis varied from 2 months to 6 years. All patients had a previous diagnosis of irritable bowel syndrome. All patients were in complete clinical remission during the treatment and referred no side effects of the drug.

CONCLUSION

Older females using high-risk medications are suggestive of MC. Preventing delay in the diagnosis of MC is crucial to improvement in patients´ quality of life. Budesonide MMX appears to be effective, safe and well-tolerated.

Microscopic Colitis: A Review Article

Microscopic colitis (MC) is a chronic inflammatory disease that affects the older population. Its clinical presentation includes a variety of gastrointestinal manifestations. The main symptom is chronic watery, nonbloody diarrhea. The disease has a female predominance. The diagnosis might be challenging since the symptoms are similar to other differential diagnoses, such as celiac disease, irritable bowel syndrome, Crohn's disease, bacterial overgrowth, and infectious colitis. The golden diagnostic tool for diagnosis is performing colonoscopy to obtain the colonic biopsy, which demonstrates the characteristic histological evidence needed for diagnosis. The treatment starts with an accurate diagnosis and trial of any possible offending medications. Alternatively, there are many medications, such as bismuth or budesonide, which are very effective in treating this disease. The primary objective of this detailed review is to enhance knowledge and understanding of this condition among healthcare providers to guide them with detailed information regarding epidemiology, clinical presentation, diagnosis, and appropriate management. In the assessment of individuals presenting with persistent chronic diarrhea, it is essential for healthcare providers to consider MC as a probable differential diagnosis.

Differential diagnosis of ulcerative colitis with increased diarrhea; collagenous colitis or irritable bowel syndrome? A case report

A 50-year-old man with a 20-year history of left-sided ulcerative colitis (UC) presented to our hospital with sudden onset of watery diarrhea. To this point, he had been treated with mesalazine 2.0 g/day for UC and had maintained remission. We considered that the UC had worsened. We immediately performed surveillance colonoscopy, which revealed a normal mucous membrane. The results of blood laboratory examinations were normal. Histopathology of colonic biopsies revealed new-onset collagenous colitis (CC), with a thickened subepithelial collagen band (SECB) and inactive UC. We herein report the importance of random colonic biopsies to diagnose CC even when the endoscopic appearance of the colon is normal in patients with inflammatory bowel disease with worsened diarrhea.