8. Baron JA, Senn S, Voelker M, et al. Gastrointestinal adverse effects of short-term aspirin use: a meta-analysis of published randomized controlled trials. Drugs R D 2013; 13:9–16. 9. Pareek A, Chandukar N. Comparison of gastrointestinal safety and tolerability of aceclofenac with diclofenac: a multicenter, randomized, double-blind study in patients with knee osteoarthritis. Curr Med Res Opin 2013; 29: 849–59. 10. Matheson AJ, Jarvis B. Lansoprazole: an update of its place in the management of acid-related disorders. Drugs 2001; 61: 1801–33. Letter: persisting clinical symptoms in microscopic colitis in remission – authors 0 reply N. Nyhlin* ,† , A. Wickbom* ,† , S. M. Montgomery †,‡,§,¶ , C. Tysk* ,† & J. Bohr* ,† *Department of Medicine, Division of Gastroenterology, Örebro University Hospital, € Orebro, Sweden. † School of Health and Medical Sciences, Örebro University, Örebro, Sweden. ‡ Clinical Epidemiology and Biostatistics, Örebro University Hospital, Örebro, Sweden. § The Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden. ¶ The Department of Epidemiology and Public Health, University College London, London, UK. E-mail: curt.tysk@orebroll.se doi:10.1111/apt.12810 SIRS, We thank Drs Fern andez-Banares and Gisbert for their kind and positive letter 1 about our study on long-- term prognosis for clinical symptoms and health-related quality of life in microscopic colitis (MC). 2 In addition to chronic diarrhoea, patients with MC also suffer from abdominal pain, faecal incontinence and extra-intestinal symptoms such as fatigue, arthralgia or myalgia. The long-term outcome of those clinical symp- toms is not well studied. We reported that, compared with matched controls, patients with MC had an increased occurrence of clinical symptoms such as abdominal pain, fatigue, arthralgia or myalgia several years after diagnosis, even though they were considered to be in clinical remis- sion, as they no longer had diarrhoea. We agree that more data are required to establish a causal relationship between inactive MC and presence of abdominal pain and other symptoms. As we did not use a validated irritable bowel syndrome (IBS) questionnaire, we cannot state with certainty that symptoms are caused by IBS. It is, however, well-described that clinical symp- toms of MC overlap with those of IBS and fulfil the Rome criteria for IBS. 3–5 Hence, at present it is more or less impossible to differentiate between IBS and IBS-like symptoms associated with inactive MC. Moreover, better biological markers are required to assess inflammatory activity in MC during follow-up to characterise active or inactive disease. Our study under- scores the need for a more comprehensive assessment of symptoms during clinical follow-up and in clinical trials. We need more data on these issues and the area is open for future research on pathophysiology and optimal treatment of abdominal pain and other persisting symp- toms associated with MC in remission. We are currently analysing the occurrence of associated diseases in our patient and control cohorts. ACKNOWLEDGEMENT The authors’ declarations of personal and financial inter- ests are unchanged from those in the original article. 2 REFERENCES 1. Fernández-Bañares F, Gisbert JP. Letter: persisting clinical symptoms in microscopic colitis in remission. Aliment Pharmacol Ther 2014; 40: 117–8. 2. Nyhlin N, Wickbom A, Montgomery SM, Tysk C, Bohr J. Long term symptom burden and health-related quality of life in patients with collagenous and lymphocytic colitis; a case-control study. Aliment Pharmacol Ther 2014; 39: 963–72. 3. Abboud R, Pardi DS, Tremaine WJ, Kammer PP, Sandborn WJ, Loftus EV Jr. Symptomatic overlap between microscopic colitis and irritable bowel syndrome: a prospective study. Inflamm Bowel Dis 2013; 19: 550–3. 4. Limsui D, Pardi DS, Camilleri M, et al. Symptomatic overlap between irritable bowel syndrome and microscopic colitis. Inflamm Bowel Dis 2007; 13: 175–81. 5. Madisch A, Bethke B, Stolte M, Miehlke S. Is there an association of microscopic colitis and irritable bowel syndrome–a subgroup analysis of placebo-controlled trials. World J Gastroenterol 2005; 11: 6409. 118 Aliment Pharmacol Ther 2014; 40: 117-122 ª 2014 John Wiley & Sons Ltd Letters to the Editors Alimentary Pharmacology and Therapeutics