Epidemiology, clinical presentation, associated factors, and current trends in microscopic colitis

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Abstract

Microscopic colitis has attracted the attention of internists and gastroenterologists due to its increasing incidence and the gaps in knowledge about the disease. Like other inflammatory bowel diseases, microscopic colitis frequently manifests as watery diarrhea, particularly in older patients, and significantly reduces their quality of life. This review aims to analyze the current understanding of microscopic colitis based on published studies. A literature search was conducted in PubMed and eLibrary.Ru (1976–2024) databases using the keywords microscopic colitis and микроскопический колит. Epidemiological data indicate an increasing incidence of microscopic colitis with global prevalence variability. The present study examines risk factors for microscopic colitis, including gut microbiota alterations, genetic determinants, and infectious factors, as well as the association of the disease with COVID-19. Significant risk factors for microscopic colitis include smoking and certain medications. The review discusses sex- and age-related characteristics of microscopic colitis, as well as the differentiation between collagenous and lymphocytic subtypes. According to most studies, the risk of developing microscopic colitis is associated with female sex and older age. The prevalence of collagenous colitis is notably higher among women than among men. The histological criteria, clinical presentation, and differential diagnosis of microscopic colitis are outlined, along with diagnostic criteria for incomplete forms of the disease. In addition, the study discusses non-invasive biomarkers of microscopic colitis and its associations with diseases of other systems, including autoimmune and cardiovascular conditions. Of particular interest is the frequent coexistence of microscopic colitis and celiac disease. Gaps in the knowledge of microscopic colitis are analyzed, and the issues of disease management, including achieving and maintaining clinical remission, are addressed. This review summarizes current evidence on microscopic colitis as a cause of unexplained watery diarrhea, particularly in older patients, including those in countries with low reported disease prevalence.

About the authors

Renata R. Savzikhanova

Kazan State Medical University

Author for correspondence.
Email: renatasavzihanova@mail.ru
ORCID iD: 0009-0008-5906-7476
SPIN-code: 1658-9382

Student

Russian Federation, 49 Butlerova street, 420012 Kazan

Dilyara G. Iskhakova

Kazan City Clinical Hospital No. 7 named after M.N. Sadykov

Email: iskhakova_d@mail.ru
ORCID iD: 0000-0003-3829-5302

Head of the Gastroenterology Depart.

Russian Federation, Kazan

Elena V. Khazova

Kazan State Medical University; Hospital for war veterans

Email: hazova_elena@mail.ru
ORCID iD: 0000-0001-8050-2892
SPIN-code: 7013-4320

MD, Cand. Sci. (Med.), Assoc. Prof., Depart. of Propaedeutics of Internal Diseases Named after Professor S.S. Zimnitsky; general practitioner of the outpatient clinic

Russian Federation, 49 Butlerova street, 420012 Kazan; Kazan

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