Microscopic colitis

Microscopic colitis is a condition that is clinically underrecognized as a cause of chronic or intermittent diarrhea and can be diagnosed only by mucosal biopsy. Microscopic colitis is more common in middle-age to elderly women, appears to be induced by some medications, particularly nonsteroidal antiinflammatory drugs, and has been associated with autoimmune conditions and sprue. Symptomatic treatment includes cholestyramine and antidiarrheal medications. Bismuth subsalicylate, and 5-amniosalicylates are therapeutic options; however, budesonide is more effective in achieving clinical and histologic improvement and/or remission and has been studied in more randomized trials. Use of immune modulators should be restricted to more severe cases that are steroid refractory or steroid dependent. Surgical intervention should be reserved for a very highly select group of refractory cases. Diverting ileostomy or colectomy appear to be equally effective surgical alternatives for microscopic colitis, which is not a risk factor for carcinoma.