Mistakes in microscopic colitis and how to avoid them

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Mistakes in microscopic colitis and how to avoid them

Andreas Münch

Summary

AI Generated

Microscopic colitis is an inflammatory bowel disease causing chronic watery diarrhoea, with incidence rates now exceeding classic IBD in some countries and diagnosis requiring colonoscopy with biopsy.

Colonoscopy with biopsy samples is the only way to diagnose microscopic colitis.
Incidence rates of microscopic colitis have been increasing and exceed those of classic IBD in some countries.
Histology distinguishes three subtypes: lymphocytic colitis, collagenous colitis, and the more recently introduced incomplete microscopic colitis.
Once believed rare, microscopic colitis has received more attention in recent decades.

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10

Miehlke S, Guagnozzi D, Zabana Y, et al. European guidelines on microscopic colitis: United European Gastroenterology (UEG) and European Microscopic Colitis Group (EMCG) statements and recommendations. United European Gastroenterol J Epub ahead of print 20 Aug 2020. DOI: 10.1177/2050640620951905. [Link]

Weimers P, Ankersen DV, Lophaven S, et al. Incidence and prevalence of microscopic colitis between 2001 and 2016: A Danish nationwide cohort study. J Crohns Colitis 2020; 14: 1717–1723. [Link]

Windon AL, Almazan E, Oliva-Hemker M, et al. Lymphocytic and collagenous colitis in children and adolescents: Comprehensive clinicopathologic analysis with long-term follow-up. Hum Pathol 2020; 106: 13–22. [Link]

Guagnozzi D, Arias A and Lucendo AJ. Systematic review with meta-analysis: diagnostic overlap of microscopic colitis and functional bowel disorders. Aliment Pharmacol Ther 2016; 43: 851–862. [Link]

Kamp EJ, Kane JS and Ford AC. Irritable bowel syndrome and microscopic colitis: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2016; 14: 659–668. [Link]

Wildt S, Nordgaard-Lassen I, Bendtsen F, et al. Metabolic and inflammatory faecal markers in collagenous colitis. Eur J Gastroenterol Hepatol 2007; 19: 567–574. [Link]

Fine KD and Schiller LR. AGA technical review on the education and management of chronic diarrhoea. Gastroenterology 1999; 116: 1464–1486. [Link]

Hjortswang H, Tysk C, Bohr J, et al. Defining clinical criteria for clinical remission and disease activity in collagenous colitis. Inflamm Bowel Dis 2009; 15: 1875–1881. [Link]

Verhaegh BPM, Münch A, Guagnozzi D, et al. Course of disease in patients with microscopic colitis — a European prospective incident cohort study. J Crohns Colitis Epub ahead of print 12 Jan 2021. DOI: 10.1093/ecco-jcc/jjab007. [Link]

10.

Langner C, Aust D, Ensari A, et al. Histology of microscopic colitis — review with a practical approach for pathologists. Histopathology 2015; 66: 613–626. [Link]

11.

Münch A, Mihaly E, Nagy F, et al. Budesonide as induction therapy for incomplete microscopic colitis: a randomized, placebo-controlled multicenter trial (paper submitted).

12.

Daferera N, Hjortswang H, Ignatova S, et al. Single-centre experience with anti-tumour necrosis factor treatment in budesonide-refractory microscopic colitis patients. United European Gastroenterol J 2019; 7: 1234–1240. [Link]

13.

Pihl Lesnovska K, Münch A and Hjortswang H. Microscopic colitis: struggling with an invisible, disabling disease. J Clin Nurs 2019; 28: 3408–3415. [Link]

14.

Hjortswang H, Tysk C, Bohr J, et al. Health-related quality of life is impaired in active collagenous colitis. Dig Liver Dis 2011; 43: 102–109. [Link]

Abstract

Microscopic colitis is an inflammatory bowel disease (IBD) that leads to chronic, watery diarrhoea. First believed to be rare, microscopic colitis has received more attention in recent decades, resulting in increasing incidence rates that exceed those of classic IBD in some countries. Hopefully, it is common practice nowadays to refer patients with chronic diarrhoea for a colonoscopy with biopsy samples taken, as this is the only way to diagnose microscopic colitis. Histology results distinguish between the subtypes of microscopic colitis — lymphocytic colitis, collagenous colitis and the more recently introduced incomplete microscopic colitis.

Topics

IBD

Citation

Münch A. Mistakes in microscopic colitis and how to avoid them. UEG Education 2021; 21: 10–13.

Published

2021

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Sven Francque, Pradeep Mundre

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Abstract

Topics

Hepatobiliary

Published

2026

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Mistakes in hepatitis C and how to avoid them

Ana Catarina Garcia, Gonçalo Alexandrino

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10

Weimers P, Ankersen DV, Lophaven S, et al. Incidence and prevalence of microscopic colitis between 2001 and 2016: A Danish nationwide cohort study. J Crohns Colitis 2020; 14: 1717–1723. [Link]

Guagnozzi D, Arias A and Lucendo AJ. Systematic review with meta-analysis: diagnostic overlap of microscopic colitis and functional bowel disorders. Aliment Pharmacol Ther 2016; 43: 851–862. [Link]

Kamp EJ, Kane JS and Ford AC. Irritable bowel syndrome and microscopic colitis: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2016; 14: 659–668. [Link]

Wildt S, Nordgaard-Lassen I, Bendtsen F, et al. Metabolic and inflammatory faecal markers in collagenous colitis. Eur J Gastroenterol Hepatol 2007; 19: 567–574. [Link]

Fine KD and Schiller LR. AGA technical review on the education and management of chronic diarrhoea. Gastroenterology 1999; 116: 1464–1486. [Link]

Hjortswang H, Tysk C, Bohr J, et al. Defining clinical criteria for clinical remission and disease activity in collagenous colitis. Inflamm Bowel Dis 2009; 15: 1875–1881. [Link]

10.

Langner C, Aust D, Ensari A, et al. Histology of microscopic colitis — review with a practical approach for pathologists. Histopathology 2015; 66: 613–626. [Link]

11.

Münch A, Mihaly E, Nagy F, et al. Budesonide as induction therapy for incomplete microscopic colitis: a randomized, placebo-controlled multicenter trial (paper submitted).

12.

13.

Pihl Lesnovska K, Münch A and Hjortswang H. Microscopic colitis: struggling with an invisible, disabling disease. J Clin Nurs 2019; 28: 3408–3415. [Link]

14.

Hjortswang H, Tysk C, Bohr J, et al. Health-related quality of life is impaired in active collagenous colitis. Dig Liver Dis 2011; 43: 102–109. [Link]

Abstract

Hepatitis C virus (HCV) infection remains an important global health concern. It is estimated that there are approximately 50 million people infected with HCV globally, with around 1 million new infections each year and about 242,000 deaths annually attributed to HCV-related complications. Most acute HCV infections (55–85%) become chronic due to the virus’s effective evasion strategies, with spontaneous clearance being rare once chronicity is established. This condition often progresses silently, with many individuals unaware of their infection until advanced liver damage has occurred. If left untreated, HCV can lead to severe complications, including liver cirrhosis and hepatocellular carcinoma (HCC). HCV transmission occurs mainly through percutaneous exposure to infected blood. HCV can also spread from mother to infant (vertical transmission) and, less frequently, via sexual contact.1,2 In recent years, the introduction of oral direct-acting antivirals (DAAs), with remarkable safety and effectiveness profiles, has led to a sustained virological response (SVR) in virtually all (>97%) HCV-infected patients, regardless of HCV genotype or disease stage. However, significant barriers remain, such as issues with diagnosis, access to treatment and awareness of the disease.

Here, we discuss some of the misconceptions in HCV management and provide a practical management approach grounded in evidence and clinical experience.

Topics

Hepatobiliary

Citation

Garcia A.C and Alexandrino G. Mistakes in hepatits C and how to avoid them. UEG Education 2025; 25: 14-17.

Published

2025

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UEG Mistakes In Articles

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Mistakes in gastrostomy insertion in children and adolescents and how to avoid them

Christos Tzivinikos, Ilse Broekaert, Jorge Amil Dias, Matjaz Homan

Summary

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Summary is not available for this content yet.

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10

Weimers P, Ankersen DV, Lophaven S, et al. Incidence and prevalence of microscopic colitis between 2001 and 2016: A Danish nationwide cohort study. J Crohns Colitis 2020; 14: 1717–1723. [Link]

Guagnozzi D, Arias A and Lucendo AJ. Systematic review with meta-analysis: diagnostic overlap of microscopic colitis and functional bowel disorders. Aliment Pharmacol Ther 2016; 43: 851–862. [Link]

Kamp EJ, Kane JS and Ford AC. Irritable bowel syndrome and microscopic colitis: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2016; 14: 659–668. [Link]

Wildt S, Nordgaard-Lassen I, Bendtsen F, et al. Metabolic and inflammatory faecal markers in collagenous colitis. Eur J Gastroenterol Hepatol 2007; 19: 567–574. [Link]

Fine KD and Schiller LR. AGA technical review on the education and management of chronic diarrhoea. Gastroenterology 1999; 116: 1464–1486. [Link]

Hjortswang H, Tysk C, Bohr J, et al. Defining clinical criteria for clinical remission and disease activity in collagenous colitis. Inflamm Bowel Dis 2009; 15: 1875–1881. [Link]

10.

Langner C, Aust D, Ensari A, et al. Histology of microscopic colitis — review with a practical approach for pathologists. Histopathology 2015; 66: 613–626. [Link]

11.

Münch A, Mihaly E, Nagy F, et al. Budesonide as induction therapy for incomplete microscopic colitis: a randomized, placebo-controlled multicenter trial (paper submitted).

12.

13.

Pihl Lesnovska K, Münch A and Hjortswang H. Microscopic colitis: struggling with an invisible, disabling disease. J Clin Nurs 2019; 28: 3408–3415. [Link]

14.

Hjortswang H, Tysk C, Bohr J, et al. Health-related quality of life is impaired in active collagenous colitis. Dig Liver Dis 2011; 43: 102–109. [Link]

Abstract

Adequate nutrition is essential for the homeostasis of fluids and nutrients, growth and thriving, especially in children. While the underlying principle of percutaneous endoscopic gastrostomy (PEG) placement is the same for both adults and children—providing a means of enteral feeding through the stomach—the indications, considerations and techniques differ owing to anatomical differences, age-dependent physiological concerns, and the age- and disease-specific needs of the child.

If feeding via nasogastric tube (NGT) or naso-jejunal tube (NJT) is necessary for a prolonged time, placement of a PEG or percutaneous endoscopic gastro-jejunal (PEG-J) tube should be considered. A PEG tube also allows the delivery of medications and venting of the stomach when needed. Nutrition via PEG facilitates the transition to out-of-hospital care and improves the quality of life (QoL) for children and families while improving the outcome of children with chronic diseases.

There are recent clinical guidelines providing guidance for PEG tube placement in children, but little advice on, e.g., choosing the right device for the right patient, details on postoperative management, removal of the PEG tube and other specific cases. The following article provides a combination of evidence-based data and the authors’ clinical experience.

Topics

Paediatrics Small Intestine & Nutrition Stomach & H. Pylori

Citation

Broekaert I.J, Dias J.A, Homan M and Tzivinikos C. Mistakes in gastrostomy insertion in children and adolescents and how to avoid them. UEG Education 2024; 24: 34-38.

Published

2024

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UEG Mistakes In Articles

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Mistakes in eosinophilic oesophagitis and how to avoid them

Alfredo J. Lucendo, Javier Molina-Infante

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10

Weimers P, Ankersen DV, Lophaven S, et al. Incidence and prevalence of microscopic colitis between 2001 and 2016: A Danish nationwide cohort study. J Crohns Colitis 2020; 14: 1717–1723. [Link]

Guagnozzi D, Arias A and Lucendo AJ. Systematic review with meta-analysis: diagnostic overlap of microscopic colitis and functional bowel disorders. Aliment Pharmacol Ther 2016; 43: 851–862. [Link]

Kamp EJ, Kane JS and Ford AC. Irritable bowel syndrome and microscopic colitis: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2016; 14: 659–668. [Link]

Wildt S, Nordgaard-Lassen I, Bendtsen F, et al. Metabolic and inflammatory faecal markers in collagenous colitis. Eur J Gastroenterol Hepatol 2007; 19: 567–574. [Link]

Fine KD and Schiller LR. AGA technical review on the education and management of chronic diarrhoea. Gastroenterology 1999; 116: 1464–1486. [Link]

Hjortswang H, Tysk C, Bohr J, et al. Defining clinical criteria for clinical remission and disease activity in collagenous colitis. Inflamm Bowel Dis 2009; 15: 1875–1881. [Link]

10.

Langner C, Aust D, Ensari A, et al. Histology of microscopic colitis — review with a practical approach for pathologists. Histopathology 2015; 66: 613–626. [Link]

11.

Münch A, Mihaly E, Nagy F, et al. Budesonide as induction therapy for incomplete microscopic colitis: a randomized, placebo-controlled multicenter trial (paper submitted).

12.

13.

Pihl Lesnovska K, Münch A and Hjortswang H. Microscopic colitis: struggling with an invisible, disabling disease. J Clin Nurs 2019; 28: 3408–3415. [Link]

14.

Hjortswang H, Tysk C, Bohr J, et al. Health-related quality of life is impaired in active collagenous colitis. Dig Liver Dis 2011; 43: 102–109. [Link]

Abstract

Eosinophilic oesophagitis (EoE) is a chronic immune-mediated inflammatory condition that is confined to the oesophagus. Clinically, EoE is characterized by symptoms of oesophageal dysfunction; histologically, by eosinophil-predominant inflammation.1,2 At present, EoE is the second-most frequent cause of chronic oesophagitis (gastro-oesophageal reflux disease [GORD] is the primary cause) and the foremost cause of dysphagia and food impaction in young adults and children.

Topics

Oesophagus

Citation

Molina-Infante J and Lucendo AJ. Mistakes in eosinophilic oesophagitis and how to avoid them. UEG Education 2017: 17; 6–9.

Published

2024

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UEG Standards and Guidelines

Clinical Practice Guideline

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ECCO Guidelines on Therapeutics in Ulcerative Colitis: Medical Treatment

Javier P. Gisbert

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Guideline

Introduction

Ulcerative colitis [UC] is a chronic inflammatory bowel disease [IBD] characterised by colonic inflammation extending to a variable extent from the rectum. Care of the patient with UC requires appropriate input from across the multiprofessional team. These guidelines summarise the recommended medical treatment for adults with UC.

In 2022, the European Crohn’s and Colitis Organisation [ECCO] published new guidelines on the management of UC in two papers focused on the medical and surgical management of the disease.¹^,² For the 2022 UC guidelines, ECCO adopted the Grading of Recommendations Assessment, Development, and Evaluation [GRADE] approach, a systematic process for developing guidelines that addresses how to frame healthcare questions, summarise the evidence, formulate recommendations, and grade their strength and the quality of associated evidence.³ The present paper represents an update to the 2022 guidelines and focuses specifically on the medical management of UC, while a companion paper developed as part of the same process addresses optimal surgical management [ECCO Guidelines on Therapeutics in Ulcerative Colitis: Surgical Treatment].

For this iteration of the guidelines, we have introduced several new, clinically relevant questions selected by members of the guidelines group, alongside a systematic approach to reviewing and updating previous topics to incorporate new evidence and to reappraise all findings within the context of contemporary practice. We have also introduced several “practice points” to summarise evidence and provide expert recommendations in key areas where the evidence remains limited but clinical decisions are still required. In such instances, where application of the GRADE methodology may be impractical, we adopted an approach based on systematic literature review, expert discussion, and voting to reach consensus recommendations outside the formal GRADE process.

Patients living with UC can have a variable disease course.⁴ In this document, we discuss therapeutic approaches stratified by disease severity [mildly-to-moderately active and moderately-to-severely active disease]. Definitions of disease severity are commonly used to establish clinical trial inclusion criteria and may be based on several distinct assessment frameworks.⁵ It is also important to remember that these definitions capture severity at a given point in time and may not reflect the cumulative long-term burden of disease experienced by a patient.⁶

It is also important to consider disease extent when planning treatment in UC, as this may affect the optimal route of drug administration. This is typically defined according to disease involving the rectum only [proctitis], disease distal to the splenic flexure [left-sided or distal UC], or disease extending proximal to the splenic flexure [extensive UC].⁷ It should be noted that disease distribution can change⁴ and that proximal disease extension can be a negative prognostic marker.⁸

Publisher

European Crohn’s and Colitis Organisation

Guideline

Clinical Practice Guideline

Topics

IBD

Citation

Journal of Crohn's and Colitis, Volume 20, Issue 7, July 2026

Published

2026

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Alfredo J. Lucendo

ECCO Guidelines on Therapeutics in Ulcerative Colitis: Medical Treatment

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UEG Mistakes In Articles

New

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Mistakes in the management of hepatocellular carcinoma and how to avoid them

Spyridon Pantzios, Ioannis Elefsiniotis, Christos Triantos

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10

Weimers P, Ankersen DV, Lophaven S, et al. Incidence and prevalence of microscopic colitis between 2001 and 2016: A Danish nationwide cohort study. J Crohns Colitis 2020; 14: 1717–1723. [Link]

Guagnozzi D, Arias A and Lucendo AJ. Systematic review with meta-analysis: diagnostic overlap of microscopic colitis and functional bowel disorders. Aliment Pharmacol Ther 2016; 43: 851–862. [Link]

Kamp EJ, Kane JS and Ford AC. Irritable bowel syndrome and microscopic colitis: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2016; 14: 659–668. [Link]

Wildt S, Nordgaard-Lassen I, Bendtsen F, et al. Metabolic and inflammatory faecal markers in collagenous colitis. Eur J Gastroenterol Hepatol 2007; 19: 567–574. [Link]

Fine KD and Schiller LR. AGA technical review on the education and management of chronic diarrhoea. Gastroenterology 1999; 116: 1464–1486. [Link]

Hjortswang H, Tysk C, Bohr J, et al. Defining clinical criteria for clinical remission and disease activity in collagenous colitis. Inflamm Bowel Dis 2009; 15: 1875–1881. [Link]

10.

Langner C, Aust D, Ensari A, et al. Histology of microscopic colitis — review with a practical approach for pathologists. Histopathology 2015; 66: 613–626. [Link]

11.

Münch A, Mihaly E, Nagy F, et al. Budesonide as induction therapy for incomplete microscopic colitis: a randomized, placebo-controlled multicenter trial (paper submitted).

12.

13.

Pihl Lesnovska K, Münch A and Hjortswang H. Microscopic colitis: struggling with an invisible, disabling disease. J Clin Nurs 2019; 28: 3408–3415. [Link]

14.

Hjortswang H, Tysk C, Bohr J, et al. Health-related quality of life is impaired in active collagenous colitis. Dig Liver Dis 2011; 43: 102–109. [Link]

Abstract

Liver cancer is the sixth most common cancer and the third leading cause of cancer-related death. Hepatocellular carcinoma (HCC) accounts for about 90% of cases and mostly arises in chronic liver disease, especially cirrhosis. Viral hepatitis remains a leading cause, but alcohol-related disease and MASLD are rising. With immune checkpoint inhibitors transforming HCC management, it is timely to highlight common mistakes across screening, staging, diagnosis and treatment.

Topics

Digestive Oncology Hepatobiliary

Published

2026

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Mistakes in eosinophilic oesophagitis and how to avoid them

Alfredo J. Lucendo

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