Diagnosis and treatment of microscopic colitis: position paper on behalf of the Brazilian Federation of Gastroenterology

Microscopic colitis (MC) is a chronic inflammatory condition of the colon, primarily characterized by watery diarrhea, with normal or
near-normal endoscopic findings. It encompasses two main subtypes: lymphocytic colitis and collagenous colitis.

This position paper from the Brazilian Federation of Gastroenterology aims to review current evidence on the
diagnosis and management of MC in Brazil, emphasizing the need for standardization across the country’s healthcare systems.

A comprehensive review of the latest scientific literature, clinical guidelines, and consensus statements was performed, focusing on randomized clinical trials, meta-analyses, and cohort studies. The evidence was analyzed by a panel of gastroenterologists and pathologists specializing in MC. The recommendations were based on the consensus of the group, approved by the majority of the panel members.

Histological examination with biopsies from multiple segments of the colon remains essential for the accurate diagnosis of MC, as endoscopic findings are often non-specific. Budesonide is the first-line treatment for inducing remission in most patients. However, alternatives such as immunosuppressants and biologics are available for those who are refractory to or intolerant of budesonide. Non-pharmacological interventions, including dietary and lifestyle modifications, can complement medical treatment. The need for long-term follow-up is highlighted due to the high recurrence rates and the impact of MC on the
quality of life.

Standardizing the diagnosis and treatment of MC in Brazil is crucial, given the significant regional disparities in healthcare access. This position paper provides evidence-based recommendations to optimize care and improve patient outcomes across diverse clinical settings in Brazil. Further research is needed to address the gaps in understanding the epidemiology and management of MC in underserved regions.

Lymphocytic colitis; collagenous colitis; microscopic colitis; chronic
diarrhea.