Guideline for treatment of microscopic colitis
Delhi: A review by Stephan Miehlke and the team brought a set of guidelines and recommendations to treat microscopic colitis. It is published in the journal United European Gastroenterology journal. The guideline was developed by United European Gastroenterology in collaboration with the European Microscopic Colitis Group.
The overall prevalence for microscopic colitis was reported to be 103.0 per 100,000 persons and splits up into 39.3 per 100,000 persons for collagenous colitis and 63.7 per 100,000 persons for lymphocytic colitis.
The objective of the study was to come up with a set of guidelines to treat micro colitis With ongoing uncertainties and new developments in the clinical management of microscopic colitis, there is a need for evidence-based guidelines to improve the medical care of patients suffering from this disorder.
The reviewers developed guidelines by the members from the European Microscopic Colitis Group and United European Gastroenterology in accordance with the Appraisal of Guidelines for Research and Evaluation II instrument. Following a systematic literature review, the Grading of Recommendations Assessment, Development, and Evaluation methodology were used to assess the certainty of the evidence. Statements and recommendations were developed by working groups consisting of gastroenterologists, pathologists, and basic scientists, and voted upon using the Delphi method.
The reviewers came up with the guidelines that provided information on epidemiology and risk factors of microscopic colitis, as well as evidence-based statements and recommendations on diagnostic criteria and treatment options, including oral budesonide, bile acid binders, immunomodulators, and biologics. Recommendations on the clinical management of microscopic colitis are provided based on evidence, expert opinion, and best clinical practice.
Key recommendations include:
- It is suggested to consider withdrawal of any drugs with a suspected chronological relationship between drug introduction and onset of diarrhea.
- MC does not increase the risk of CRC or adenoma. A special surveillance colonoscopy program is not recommended.
- Ileocolonoscopy with biopsies is recommended from at least the right and left side of the colon.
- Histological monitoring is not recommended in patients with MC.
- Screening for coeliac disease is recommended in patients with MC.
- Testing for bile acid diarrhea can be considered in patients who experience nonresponse to budesonide treatment.
- The use of oral budesonide is recommended to induce remission in patients with CC.
- Oral budesonide use is recommended to induce remission in patients with LC.
- The use of oral budesonide is not recommended to maintain remission in patients with CC.
- Oral budesonide use is recommended to maintain remission in patients with LC.
- Treatment with mesalazine is not recommended in patients with MC for induction of remission. There are no studies for maintenance.
- There is not enough evidence to recommend bismuth subsalicylate in patients with MC.
- There is not enough evidence to recommend the use of loperamide in MC. Given the documented effect in patients with chronic diarrhea, the expert's opinion favors the use of this drug in mild disease.
- In patients with MC and bile acid diarrhea, the authors suggest treatment with bile acid binders.
- There is not enough evidence to recommend antibiotics for the treatment of MC.
- The use of probiotics is not recommended for the treatment of MC.
- The use of prednisolone or other corticosteroids than budesonide is not recommended for the treatment of MC.
- Treatment with thiopurines, anti-tumor necrosis factor (TNF) drugs, or vedolizumab is recommended in selected patients with MC who fail to respond to budesonide to induce and maintain clinical remission. The use of methotrexate is not recommended in patients with MC.
- Surgery can be considered in selected patients as the last option if all medical therapy fails.
The reviewers concluded, "These guidelines may support clinicians worldwide to improve the clinical management of patients with microscopic colitis." They also stated that several unmet needs had been identified, including a better understanding of the natural course and pathophysiological mechanisms of disease, reliable noninvasive biomarkers, validated instruments for the assessment of disease activity, and new treatment modalities. These gaps should be addressed by high-quality basic research and well-designed clinical trials.
"European guidelines on microscopic colitis: United European Gastroenterology and European Microscopic Colitis Group statements and recommendations," is published in the journal United European Gastroenterology.