Microscopic Colitis: Evidence-Based Guide to Diagnosis and Management

Abstract

Microscopic colitis (MC), which predominately affects older adults, is a chronic inflammatory bowel disease characterized by watery diarrhea. Diagnosis relies on histological examination, as there are no established biomarkers to facilitate noninvasive diagnosis, and endoscopic findings are typically unremarkable. MC is classified into subtypes of lymphocytic and collagenous colitis. First-line therapy is budesonide (9 mg/day for 6–8 weeks), which induces remission effectively. However, relapse rates are high, necessitating alternative treatment strategies. Long-term maintenance strategies include low-dose budesonide, bile salt binders, antidiarrheals, and advanced therapies for refractory cases.