From the Guidelines
Four effective treatment options for microscopic colitis beyond loperamide and cholestyramine include budesonide, bismuth subsalicylate, systemic corticosteroids, and mesalamine.
Treatment Options
- Budesonide, a locally acting corticosteroid, is considered first-line therapy at 9 mg daily for 6-8 weeks, followed by a tapering schedule, as it reduces inflammation with minimal systemic side effects 1.
- Bismuth subsalicylate can be used at 262 mg three times daily for 8 weeks, working through its anti-inflammatory and antibacterial properties 1.
- For severe cases unresponsive to budesonide, systemic corticosteroids like prednisone at 40 mg daily with gradual tapering may be necessary, though they carry more significant side effects 1.
- Mesalamine is also an option, particularly when budesonide is not feasible, with a conditional recommendation over no treatment for the induction of clinical remission 1.
Key Considerations
- The choice of treatment should be based on the individual patient's needs and circumstances, taking into account the potential benefits and risks of each option.
- Lifestyle modifications, such as avoiding NSAIDs, caffeine, alcohol, and lactose-containing foods, can also help alleviate symptoms and are important adjuncts to medication.
- The American Gastroenterological Association (AGA) guidelines provide a framework for the medical management of microscopic colitis, emphasizing the importance of evidence-based decision-making and individualized patient care 1.
From the Research
Treatment Options for Microscopic Colitis
Other than loperamide and cholestyramine, the following treatment options are available for microscopic colitis:
- Budesonide: a corticosteroid that has been shown to be effective in inducing and maintaining clinical remission in patients with microscopic colitis 2, 3, 4, 5, 6
- Bismuth subsalicylate: an antimicrobial and anti-inflammatory agent that may be effective in treating microscopic colitis 3, 5, 6
- Mesalamine: an aminosalicylate that may be effective in treating microscopic colitis, although the evidence is weaker than for budesonide 4, 6
- Azathioprine or methotrexate: immunomodulators that may be used in patients with refractory microscopic colitis 2, 4