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World J Gastroenterol. Oct 7, 2011; 17(37): 4157-4165
Published online Oct 7, 2011. doi: 10.3748/wjg.v17.i37.4157
Distinct colonoscopy findings of microscopic colitis: Not so microscopic after all?
Anastasios Koulaouzidis, Athar A Saeed
Anastasios Koulaouzidis, Endoscopy Unit, Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, EH164SA Edinburgh, Scotland, United Kingdom
Athar A Saeed, Gastroenterology Department, Queen Elizabeth Hospital, NE96SX Gateshead, England, United Kingdom
Author contributions: Koulaouzidis A and Saeed AA contributed equally to this work; Koulaouzidis A designed the paper and performed the research; Koulaouzidis A and Saeed AA analyzed the data; and Koulaouzidis A and Saeed AA wrote the paper.
Correspondence to: Anastasios Koulaouzidis, MD, MRCP, FEBG, Endoscopy Unit, Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH164SA, Scotland, United Kingdom.
Telephone: +44-131-2421126 Fax: +44-131-2421618
Received: February 3, 2011
Revised: May 20, 2011
Accepted: May 27, 2011
Published online: October 7, 2011

Microscopic colitis (MC) is considered an “umbrella term”, comprising two subtypes, i.e., collagenous colitis (CC) and lymphocytic colitis (LC). They are classically associated with normal or unremarkable colonoscopy. In the last few years, reports have been published revealing findings that are thought to be characteristic or pathognomonic of MC, especially CC. A systematic electronic and manual search of PubMed and EMBASE (to December 2010), for publications on distinct endoscopic findings in MC, resulted in 42 relevant reports for inclusion in this review. Eighty eight patients with collagenous colitis were presented. Only one publication describing a distinct endoscopic pattern in LC was found. Typical findings in CC are alteration of the vascular mucosal pattern, mucosal nodularity, a sequence of change from mucosal defects to mucosal cicatricial lesions, and perhaps (although of doubtful relevance) mucosal pseudomembranes. A causal connection of mucosal defects with the use of lansoprazole seems to exist. Adoption of the proposed lesion description herein is recommended in order to improve homogeneity of future reports.

Keywords: Collagenous colitis, Microscopic colitis, Endoscopy, Mucosa, Lesion