European guidelines on microscopic colitis: United European Gastroenterology and European Microscopic Colitis Group statements and recommendations

Stephan Miehlke, Danila Guagnozzi, Yamile Zabana, Gian E Tontini, Anne-Marie Kanstrup Fiehn, Signe Wildt, Johan Bohr, Ole Bonderup, Gerd Bouma, Mauro D'Amato, Peter J Heiberg Engel, Fernando Fernandez-Banares, Gilles Macaigne, Henrik Hjortswang, Elisabeth Hultgren-Hörnquist, Anastasios Koulaouzidis, Jouzas Kupcinskas, Stefania Landolfi, Giovanni Latella, Alfredo Lucendo, Ivan Lyutakov, Ahmed Madisch, Fernando Magro, Wojciech Marlicz, Emese Mihaly, Lars K Munck, Ann-Elisabeth Ostvik, Árpád V Patai, Plamen Penchev, Karolina Skonieczna-Żydecka, Bas Verhaegh, Andreas Münch, Stephan Miehlke, Danila Guagnozzi, Yamile Zabana, Gian E Tontini, Anne-Marie Kanstrup Fiehn, Signe Wildt, Johan Bohr, Ole Bonderup, Gerd Bouma, Mauro D'Amato, Peter J Heiberg Engel, Fernando Fernandez-Banares, Gilles Macaigne, Henrik Hjortswang, Elisabeth Hultgren-Hörnquist, Anastasios Koulaouzidis, Jouzas Kupcinskas, Stefania Landolfi, Giovanni Latella, Alfredo Lucendo, Ivan Lyutakov, Ahmed Madisch, Fernando Magro, Wojciech Marlicz, Emese Mihaly, Lars K Munck, Ann-Elisabeth Ostvik, Árpád V Patai, Plamen Penchev, Karolina Skonieczna-Żydecka, Bas Verhaegh, Andreas Münch

Abstract

Introduction: Microscopic colitis is a chronic inflammatory bowel disease characterised by normal or almost normal endoscopic appearance of the colon, chronic watery, nonbloody diarrhoea and distinct histological abnormalities, which identify three histological subtypes, the collagenous colitis, the lymphocytic colitis and the incomplete microscopic 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.

Methods: Guidelines were developed by 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 was 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.

Results: These guidelines provide 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.

Conclusion: These guidelines may support clinicians worldwide to improve the clinical management of patients with microscopic colitis.

Keywords: budesonide; diarrhoea; inflammatory bowel disease; microscopic colitis.

Conflict of interest statement

There are no industry or government relationships to report: Johan Bohr, Mauro D'Amato, JE, Anne‐Marie Kanstrup Fiehn, Jouzas Kupcinskas, Giovanni Latella, Ivan Lyutakov, Gilles Macaigne, Fernando Magro, Emese Mihaly, Lars Kristian Munck, Árpád V. Patai, Karolina Skonieczna‐Zydecka, Bas Verhaegh. Advisory boards, consulting: Stephan Miehlke: Dr Falk Pharma, Tillotts; Yamile Zabana: Tillotts, Janssen, FAES; Fernando Fernandez‐Banares: Tillotts, Thermofisher; Henrik Hjortswang: Abbvie, Janssen, Pfizer, Takeda, Tillotts; Anastasios Koulaouzidis: Tillotts, Dr Falk Pharma; Wojciech Marlicz Sanprobi; Ahmed Madisch: Dr Falk Pharma; Ole Bonderup: Tillotts; Gian E. Tontini: Aorta SRL, CapsoVision Inc; Andreas Münch: Ferring, Tillotts, Dr Falk Pharma; Signe Wildt: Tillotts, Takeda. Research grants/clinical trial funding: Ole Bonderup: Tillotts; Fernando Fernandez‐Banares: Dr Falk Pharma; Henrik Hjortswang: Abbvie, Ferring, Tillotts, Biomedal; Andreas Münch: Ferring. Speaker's bureau: Stephan Miehlke: Dr Falk Pharma/Falk Foundation; Yamile Zabana: Abbvie, MSD, Ferring; Danila Guagnozzi: Allergan; Ole Bonderup: Dr Falk Pharma/Falk Foundation, Tillotts; Henrik Hjortswang: Abbvie, Tillotts; Anastasios Koulaouzidis: Dr Falk Pharma; Ahmed Madisch: Dr Falk Pharma/Falk Foundation; Wojciech Marlicz: Alfasigma; Andreas Münch: Tillotts.

© 2020 The Authors. United European Gastroenterology Journal published by Wiley Periodicals LLC. on behalf of United European Gastroenterology.

Figures

FIGURE 1
FIGURE 1
Therapeutic algorithm for microscopic colitis in clinical practice. *Smoking, NSAID, PPI; **for example bile acid diarrhoea, coeliac disease. NSAID, nonsteroidal anti‐inflammatory drugs; PPI, proton pump inhibitor

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