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What do we know today about drug-induced microscopic colitis? A case of lymphocytic colitis on olmesartan

Journal Volume 86 - 2023
Issue Fasc.3 - Reviews
Author(s) A. Djembissi Fotso 1 2, M. Arvanitakis 2, M. Salame 1, J. Gallez 1, A. Lakis 1
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Full Article
PAGES 474-480
(1) Department of Gastroenterology, Centre Hospitalier Régional de la Haute Senne, Soignies, Belgium
(2) Department of Gastroenterology, Erasme Hospital, Université Libres de Bruxelles (ULB), Brussels, Belgium

Microscopic colitis is part of the differential diagnosis of chronic watery diarrhea. Colonoscopy discloses a normal looking mucosa, therefore its diagnosis is based on histology of colonic biopsies. Two main phenotypes are distinguished: collagenous colitis and lymphocytic colitis. A third entity, incomplete microscopic colitis or unspecified microscopic colitis has been reported in the literature. It affects preferentially women over 60 years of age and its association with certain drugs is increasingly established. In case of suspected drug-induced microscopic colitis, identification of the responsible drug is a key to management. After discontinuation of the suspected drug, the gold standard of treatment is budesonide both for induction and for maintenance in case of clinical relapse, as is often the case after discontinuation. Therapy with immunomodulators, biologics, or surgery is reserved for refractory forms of microscopic colitis after multidisciplinary consultation. Through the clinical case of colitis on olmesartan, we will review the latest recommendations on drug-induced microscopic colitis.

Keywords: microscopic colitis, collagenous colitis, lymphocytic colitis, olmesartan.

The authors declare that they have no conflict of interest.
© Acta Gastro-Enterologica Belgica.
PMID 37814563