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We read with great interest the recent work by Schreiber et al1 which highlights that clinical and molecular heterogeneity of inflammatory bowel disease (IBD) poses a major challenge to personalised treatment strategies. Their call for a more dynamic approach to IBD management resonates with the situation in microscopic colitis (MC), prompting us to examine current treatment patterns in MC. While patients with MC may respond to symptomatic treatment alone, budesonide remains the only therapy evaluated in randomised trials for MC.2 Despite its efficacy and favourable safety profile, some 50% of patients relapse on withdrawal and may require long-term maintenance or escalation to biologics.3 Notably, patients with MC have also been found to be at an increased risk of colectomy,4 underscoring the potential for severe disease progression. Moreover, emerging evidence has highlighted the substantial economic burden of MC, which could potentially be reduced by improved symptom control.5