Microscopic colitis and the role of the specialist inflammatory bowel disease nurse: a clinical review

Abstract

Microscopic colitis (MC) is an inflammatory bowel condition similar to but distinct from classical inflammatory bowel disease (IBD). Unlike ulcerative colitis and Crohn's disease, MC is predominately a self-limiting and treatable condition. It is characterised by colonic inflammation and symptoms of watery, non-bloody diarrhoea, alongside abdominal pain and weight loss, causing anxiety, fatigue and reduced quality of life. The prevalence of MC is 119 per 100 000 population and growing. Its aetiology and pathophysiology are poorly understood, but it is likely multifactorial, and possible risk factors include smoking and certain medications and autoimmune conditions. Diagnosis relies on endoscopic biopsy to identify intraepithelial lymphocytosis. Management and treatment begin with excluding possible risk factors and can include anti-diarrhoeal medications, bile acid binders and budesonide, which is highly effective at inducing and maintaining remission. Refractory disease is rare, but it may require biological medications or even surgery. Disease activity is monitored with the Hjortswang criteria and Microscopic Colitis Disease Activity Index. This narrative clinical review draws on recent guidelines and study data to explore the uncertain role of the clinical nurse specialist in caring for these patients.