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Microscopic Colitis

Microscopic Colitis is a topic covered in the 5-Minute Clinical Consult.

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  • Microscopic colitis (MC) is a relatively common cause of chronic, recurrent nonbloody diarrhea and has two subtypes: collagenous and lymphocytic colitis (LC). It is typically associated with autoimmune diseases and/or certain medications. Diagnosis requires a colonic biopsy with histologic tissue analysis.
  • No significant difference in management of collagenous versus LC


  • Up to 20–30% of chronic diarrhea is thought to be secondary to MC.
  • Since 1985, the incidence in the United States has increased from 1 to 20 per 100,000 person-years.

  • Prevalence ~103/100,000 persons
  • More common in older individuals. The average age at diagnosis is 53 to 69 years.
  • Female > male; ranging between 3:1 and 9:1

Etiology and Pathophysiology

  • Unclear etiology; strong association with autoimmune diseases, smoking, and certain medications
  • Models of pathogenesis include autoimmune destruction, inflammatory response to luminal factors, and myofibroblast dysfunction (for collagenous colitis [CC]).
  • Animal models indicate bacterial translocation may play a role by inducing an inflammatory cascade in colonic mucosa which leads to increased mucosal permeability, increased cytokine release, degradation of collagen matrix, and dysregulation of subepithelial myofibroblasts.

No specific genetic mutation has been identified, but increased prevalence of human leukocyte antigen DR3 DQ2 allele noted in patients with MC.

Risk Factors

  • Nonsteroidal anti-inflammatory drugs
  • Proton pump inhibitors
  • Statins
  • β-Blockers
  • Smoking

General Prevention

  • Judicious use of associated medications
  • Smoking cessation

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Stephens, Mark B., et al., editors. "Microscopic Colitis." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816865/all/Microscopic_Colitis.
Microscopic Colitis. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816865/all/Microscopic_Colitis. Accessed April 18, 2019.
Microscopic Colitis. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816865/all/Microscopic_Colitis
Microscopic Colitis [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 18]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816865/all/Microscopic_Colitis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Microscopic Colitis ID - 816865 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816865/all/Microscopic_Colitis PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -