Microscopic colitis (MC) is a form of inflammatory bowel disease characterized by chronic, water, nonbloody diarrhea and symptoms such as fecal urgency, incontinence and abdominal pain often reducing quality of life. Despite normal endoscopic findings, MC diagnosis relies on histological evaluation distinguishing three subtypes: Lymphocytic colitis (LC), collagenous colitis (CC), and incomplete MC. LC and CC show increased intraepithelial lymphocytes and thickened intestinal mucosal collagen bands, respectively. Incomplete MC presents diagnostic challenges due to overlapping features with normal or irritable bowel syndrome mucosa. Risk factors include older age, female sex, autoimmune diseases, previous gastrointestinal infections, smoking and alcohol use, while lower risk is seen in individuals of Asian, Hispanic/Latino or African American descent, and women with obesity. Some medications are linked to MC, though recent studies question some of these associations, highlighting the disease complexity and need for further research. In this review we illustrate current treatment approaches in MC.

Keywords:Microscopic colitis; Collagenous colitis; Lymphocytic colitis; Treatment approaches; Budesonide; Biologics; Immunomodulators; Small molecules

Abbreviations: CC: Collagenous Colitis; LC: Lymphocytic Colitis; MC: Microscopic Colitis