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Microscopic colitis

Last reviewed: 2 Apr 2025
Last updated: 22 Aug 2023

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • chronic watery, nonbloody diarrhea
Full details

Other diagnostic factors

  • fecal urgency
  • fecal incontinence
  • nocturnal stools
  • abdominal pain
  • weight loss
  • bloating
  • fatigue
Full details

Risk factors

  • age >50 years
  • cigarette smoking
  • female sex
  • autoimmune disorders
  • use of certain medications
Full details

Diagnostic tests

1st tests to order

  • CBC
  • basic metabolic panel
  • CRP
  • erythrocyte sedimentation rate
  • immunoglobulin A-tissue transglutaminase
  • stool studies for infective pathogens
  • stool O+P
  • lateral flow immunoassay (Giardia)
  • ileocolonoscopy
  • colonic biopsies
Full details

Tests to consider

  • flexible sigmoidoscopy with biopsies
Full details

Treatment algorithm

ACUTE

mild to moderate disease

severe disease

ONGOING

relapse after induction of remission

Contributors

Authors

Darrell Pardi, MD

Professor of Medicine and Chair

Division of Gastroenterology and Hepatology

Department of Internal Medicine

Mayo Clinic

Rochester

MN

Disclosures

DP declares they have undertaken general consulting for Otsuka Pharmaceutical Development and Commercialization, Inc., Immunic Therapeutics, Rise Therapeutics, and Phathom Pharmaceuticals, Inc. DP has been on advisory boards for AbbVie, Inc., 3D Communications, Et al. Scientific, Summit Therapeutics, Boehringer Ingelheim Pharmaceuticals, Inc., and Ferring Pharmaceuticals, Inc. DP has received grants (to their institution) for research projects from Rise Therapeutics, Seres Therapeutics, Pfizer, and Alimentiv. DP is the author of references cited in this topic.

Sahil Khanna, MBBS, MS

Professor of Medicine

Division of Gastroenterology and Hepatology

Department of Internal Medicine

Mayo Clinic

Rochester

MN

Disclosures

SK declares no competing interests.

Raseen Tariq, MBBS

Instructor in Medicine

Division of Gastroenterology and Hepatology

Department of Internal Medicine

Mayo Clinic

Rochester

MN

Disclosures

RT declares no competing interests.

Peer reviewers

David S. Sanders, MB, ChB, MD, FRCP, FACG

Chair of the Coeliac UK Health Advisory Council

Honorary Professor of Gastroenterology

University of Sheffield

Consultant Gastroenterologist

Sheffield Teaching Hospitals NHS Foundation Trust

Sheffield

UK

Disclosures

DSS declares that he has no competing interests.

Joseph D Feuerstein, MD

Attending in Gastroenterology

Beth Israel Deaconess Medical Center

Associate Professor of Medicine

Harvard Medical School

Boston

MA

Disclosures

JDF declares no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Nguyen GC, Smalley WE, Vege SS, et al. American Gastroenterological Association Institute guideline on the medical management of microscopic colitis. Gastroenterology. 2016 Jan;150(1):242-6.Full text  Abstract

Arasaradnam RP, Brown S, Forbes A, et al. Guidelines for the investigation of chronic diarrhoea in adults: British Society of Gastroenterology, 3rd edition. Gut. 2018 Aug;67(8):1380-99.Full text  Abstract

Miehlke S, Guagnozzi D, Zabana Y, et al. European guidelines on microscopic colitis: United European Gastroenterology and European Microscopic Colitis Group statements and recommendations. United European Gastroenterol J. 2021 Feb 22;9(1):13-37.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Microscopic colitis images
  • Differentials

    • Food poisoning
    • Foodborne E coli infection
    • Crohn disease
    More Differentials
  • Guidelines

    • European guidelines on microscopic colitis: statements and recommendations
    • Guidelines for the investigation of chronic diarrhoea in adults
    More Guidelines
  • Patient information

    Colonoscopy

    More Patient information
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