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Is Microscopic Colitis a Drug-induced Disease?

Keszthelyi, Daniel MD*; Penders, John PhD†,‡; Masclee, Ad A. MD, PhD*; Pierik, Marieke MD, PhD*

doi: 10.1097/MCG.0b013e3182618506
Clinical Reviews

Microscopic colitis (MC) is diagnosed in up to 13% of patients investigated for chronic diarrhea, particularly in middle-aged and elderly patients. Recent studies have suggested an etiological role for various drugs, including nonsteroidal anti-inflammatory drugs and proton pump inhibitors. To ascertain the potential role for drug exposure in the development of MC, we performed a systematic review based on a MEDLINE search and conducted a meta-analyses on the available data. We also give an overview of the case reports and studies illustrating the role of drugs in inducing MC. A number of hypotheses are formulated with regard to the potential pathophysiological mechanisms in drug-induced MC. However, confirmative evidence is still largely lacking. Considering the high number of drug users and the relatively low incidence of MC, it is more likely that drug-induced cases of MC are the result of an idiosyncratic reaction.

Departments of *Internal Medicine, Division of Gastroenterology-Hepatology


Medical Microbiology, Maastricht University Medical Center, Maastricht, The Netherlands

The authors declare that they have nothing to disclose.

Reprints: Daniel Keszthelyi, MD, Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands (e-mail:

© 2012 Lippincott Williams & Wilkins, Inc.