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  • Review Article
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Lymphocytic and collagenous colitis: an overview of so-called microscopic colitis

Nature Reviews Gastroenterology & Hepatology volume 9, pages 209–218 (2012)Cite this article

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Abstract

The entity of 'microscopic colitis' is being diagnosed with increasing frequency and is a well-established clinicopathological diagnosis that is underpinned by a triad of watery diarrhea, normal results on endoscopy and characteristic microscopic findings. Careful histopathological evaluation and awareness of its numerous associations (especially with drugs and celiac disease) and mimics will lead to the correct diagnosis of microscopic colitis. The etiology of microscopic colitis remains enigmatic and is multifactorial with different elements being more influential in different individuals. Treatment includes antidiarrheal agents and anti-inflammatory drugs (including steroids). The purpose of this article is to provide some clarity on nomenclature, discuss the multitude of conditions that can occur synchronously or metachronously with microscopic colitis and their role in the etiopathogenesis of this condition, provide a detailed review of the pathological aspects of the disease and to briefly discuss treatment trends.

Key Points

  • Microscopic colitis is being diagnosed clinically and pathologically with increasing frequency

  • Microscopic colitis is well established as a leading cause of nonbloody watery diarrhea

  • Careful and meticulous exclusion of known associated diseases and drugs is recommended

  • A wide array of pathological changes can be encountered and several conditions can mimic microscopic colitis

  • Microscopic colitis remains a pathological diagnosis, but close clinical and endoscopic correlation with microscopy is essential for accurate diagnosis

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Figure 1: Typical features of lymphocytic colitis.
Figure 2: Typical features of collagenous colitis.

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Change history

  • 29 February 2012

    In the version of this article initially published online the correct citation for part 2d was not included in the legend for Figure 2. The corresponding figure legend should have read: Permission for panel d obtained from Elsevier Ltd © Taylor, F. et al. Curr. Diagn. Pathol. 12, 261–267 (2006). The error has been corrected for the print, HTML and PDF versions of the article

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Acknowledgements

D. Govender is a visiting Professor to the Nuffield Department of Clinical Laboratory Sciences, University of Oxford, UK. He is a Harry Crossley Senior Clinical Research Fellow and a recipient of a grant from the Oppenheimer Memorial Trust.

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  1. Department of Cellular Pathology and Nuffield Department of Clinical Laboratory Sciences, Oxford Biomedical Research Centre, Oxford University Hospitals Trust and University of Oxford University, Level 1 Academic Centre, John Radcliffe Hospital, Headley Way, OX3 9DU, Oxford, UK

    Runjan Chetty

  2. Division of Anatomical Pathology, University of Cape Town and National Health Laboratory Service, Groote Schuur Hospital, Anzio Road, Observatory, 7925, Cape Town, South Africa

    Dhirendra Govender

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Correspondence to Runjan Chetty.

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Chetty, R., Govender, D. Lymphocytic and collagenous colitis: an overview of so-called microscopic colitis. Nat Rev Gastroenterol Hepatol 9, 209–218 (2012). https://doi.org/10.1038/nrgastro.2012.16

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