Microscopic colitis: a misnomer for a clearly defined entity?

In recent years, several endoscopic features of microscopic colitis have been noted. The pickup of these on colonoscopy depends on local expertise, endoscopic technology, and case volume. As the incidence of microscopic colitis has increased, we wanted to draw attention to endoscopists’ ability to recognize such findings. We present eight cases of biopsy-proven microscopic colitis which demonstrate the spectrum of endoscopic findings. Endoscopists should actively search for such findings and target their biopsies, as new high-definition colonoscopes with sharper images, zoom capabilities, and high resolution allow a new vision into this syndrome.

• References

• 1 Münch A, Aust D, Bohr J et al. European Microscopic Colitis Group (EMCG). Microscopic colitis: Current status, present and future challenges: statements of the European Microscopic Colitis Group. J Crohns Colitis 2012; 6: 932-945
• 2 Storr MA. Microscopic colitis: epidemiology, pathophysiology, diagnosis and current management – an update 2013. ISRN Gastroenterology 2013; Article ID: 352718
• 3 Koulaouzidis XXXX, Saeed AA. Distinct colonoscopy findings of microscopic colitis: not so microscopic after all?. World J Gastroenterol 2011; 17: 4157-4165
• 4 Andrews CN, Beck PL, Wilsack LH et al. Evaluation of endoscopist and pathologist factors affecting the incidence of microscopic colitis. Can J Gastroenterol 2012; 26: 515-520
• 5 Suzuki G, Mellander MR, Suzuki A et al. Usefulness of colonoscopic examination with indigo carmine in diagnosing microscopic colitis. Endoscopy 2011; 43: 1100-1104
• 6 Kiesslich R, Hoffman A, Goetz M et al. In vivo diagnosis of collagenous colitis by confocal endomicroscopy. Gut 2006; 55: 591-592
• 7 Morita T, Yamamoto S, Takeuchi E. Narrow band imaging for diagnosis of collagenous colitis. Dig Endosc 2014; 26: 752-753
• 8 Bateman AC, Patel P. Lower gastrointestinal endoscopy: guidance on indications for biopsy. Frontline Gastroenterol 2013; DOI:
• 9 Park HS, Han DS, Ro Y et al. Does lymphocytic colitis always present with normal endoscopic findings?. Gut Liver DOI:
• 10 Cimmino DG, Mella JM, Pereyra L et al. A colorectal mosaic pattern might be an endoscopic feature of collagenous colitis. J Crohns Colitis 2010; 4: 139-143
• 11 Wickbom A, Lindqvist M, Bohr J et al. Colonic mucosal tears in collagenous colitis. Scand J Gastroenterol 2006; 41: 726-729
• 12 Madalinski M, Koulaouzidis A. Collagenous colitis with mucosal tears in two proton pump inhibitors and non-steroidal naive patients who developed metachronous cancer. J Dig Dis 2013; 14: 51-53