What is the treatment for microscopic colitis?

From the Guidelines

The treatment for microscopic colitis differs based on the severity of symptoms and patient response, with budesonide being the first-line medication for induction of clinical remission, as recommended by the American Gastroenterological Association (AGA) 1. The AGA guidelines suggest the following treatment options:

• Budesonide (Entocort EC) 9 mg daily for 6-8 weeks for induction of clinical remission
• Mesalamine as an alternative for patients who cannot take budesonide
• Bismuth salicylate, prednisolone, or prednisone as conditional recommendations for patients who do not respond to budesonide
• Maintenance therapy with budesonide 6 mg daily for patients who experience recurrence of symptoms after discontinuation of induction therapy 1 The treatment approach can be summarized in the following table:

  Medication	Dosage	Indication
  Budesonide	9 mg daily	Induction of clinical remission
  Mesalamine	variable	Alternative for patients who cannot take budesonide
  Bismuth salicylate	variable	Conditional recommendation for patients who do not respond to budesonide
  Prednisolone or prednisone	variable	Conditional recommendation for patients who do not respond to budesonide
  Budesonide	6 mg daily	Maintenance therapy for patients with recurrence of symptoms
  It is essential to note that the treatment should be individualized based on patient response and severity of symptoms, and that lifestyle changes such as avoiding trigger medications, reducing caffeine and alcohol intake, and eliminating gluten if sensitivity exists should also be considered 1.

From the Research

Treatment Differences for Microscopic Colitis

The treatment for microscopic colitis, which encompasses lymphocytic colitis and collagenous colitis, can vary based on the severity of symptoms and the patient's response to initial treatments.

• First-Line Treatment:
  • The initial approach often involves eliminating offending medications that may be associated with microscopic colitis, such as proton pump inhibitors, nonsteroidal anti-inflammatory drugs, selective serotonin reuptake inhibitors, and statins 2, 3.
  • For patients with mild symptoms, antidiarrheals like loperamide are commonly used for immediate symptomatic relief 2, 3.
• Moderate to Severe Disease:
  • Budesonide is recommended for the induction of clinical remission in patients with moderate to severe symptoms due to its favorable side effect profile and good efficacy 2, 3, 4.
  • Systemic glucocorticoids may be considered for patients who cannot take budesonide 3.
• Refractory Disease:
  • In cases where patients do not respond to glucocorticoids, other medications such as cholestyramine, bismuth salicylate, antibiotics, probiotics, aminosalicylates, immunomodulators, and anti-tumor necrosis factor-alpha inhibitors may be tried 3, 5.
• Maintenance Therapy:
  • For patients with recurrent symptoms, low-dose budesonide may be required for maintenance therapy, with close monitoring for potential adverse effects 2, 4.

Treatment Comparison Table

Treatment	Indication	Efficacy
Loperamide	Mild symptoms	Symptomatic relief
Budesonide	Moderate to severe symptoms	Induction of clinical remission
Systemic Glucocorticoids	Unable to take budesonide	Alternative for induction
Other medications (e.g., cholestyramine, bismuth salicylate)	Refractory disease	Variable efficacy
Low-dose Budesonide	Recurrent symptoms	Maintenance therapy

The choice of treatment should be guided by the severity of the patient's symptoms and their response to initial therapies, as outlined in studies 2, 3, 4.