From the Guidelines
The recommended treatment for lymphocytic and collagenous colitis is budesonide, an oral corticosteroid with minimal systemic absorption, at a dose of 9 mg daily for 6-8 weeks, as it effectively reduces inflammation in the colon lining and provides symptom relief for most patients 1.
Key Considerations
- Budesonide is the first-line treatment for microscopic colitis, with a strong recommendation and moderate quality of evidence 1.
- For patients who cannot take budesonide, mesalamine, bismuth salicylate, or prednisolone may be considered as alternative treatments, although the evidence for these options is less strong 1.
- Maintenance therapy with budesonide may be necessary for patients who experience recurrence of symptoms after initial treatment, with a recommended dose of 3-6 mg daily 1.
- Dietary modifications, such as avoiding caffeine, alcohol, and artificial sweeteners, can also help alleviate symptoms 1.
Treatment Options
- Budesonide: 9 mg daily for 6-8 weeks for induction of clinical remission, and 3-6 mg daily for maintenance therapy 1.
- Mesalamine: 2.4-4.8 g daily for patients who cannot take budesonide 1.
- Bismuth salicylate: two 262 mg tablets three times daily for symptomatic treatment 1.
- Prednisolone: may be considered for patients who cannot take budesonide, although the evidence is limited 1.
Important Considerations
- The goal of treatment is to relieve symptoms and improve quality of life while minimizing drug-related adverse effects 1.
- Patients with refractory symptoms should avoid potential medication triggers, such as nonsteroidal anti-inflammatory drugs, proton pump inhibitors, and selective serotonin reuptake inhibitors 1.
- Coexisting causes of chronic diarrhea, such as celiac disease, should be considered in patients with ongoing symptoms despite medical therapy 1.
From the Research
Treatment Options for Lymphocytic and Collagenous Colitis
The treatment for lymphocytic and collagenous colitis involves several options, including:
- Budesonide: a corticosteroid that has been shown to be effective in treating both lymphocytic and collagenous colitis 2, 3, 4, 5, 6
- Mesalazine: an anti-inflammatory medication that may be effective in treating lymphocytic colitis, although the evidence is weaker 4, 5
- Bismuth subsalicylate: an antibiotic that may be effective in treating lymphocytic colitis, although the evidence is limited 4, 5
- Cholestyramine: a medication that may be used in combination with mesalazine to treat lymphocytic colitis 4, 5
Efficacy of Budesonide
Budesonide has been shown to be effective in inducing clinical and histological remission in patients with lymphocytic colitis:
- In one study, 86% of patients treated with budesonide achieved clinical remission, compared to 48% of patients treated with placebo 2
- In another study, 79% of patients treated with budesonide achieved clinical remission, compared to 42% of patients treated with placebo 3
- Budesonide has also been shown to be effective in maintaining clinical and histological remission in patients with collagenous colitis 6
Safety and Tolerability
Budesonide has been shown to be well tolerated, with few adverse events reported: