From the Guidelines
Microscopic colitis is characterized by chronic watery diarrhea, with symptoms including frequent loose stools, abdominal pain, fatigue, weight loss, urgency, and nighttime bowel movements. The symptoms of microscopic colitis can significantly impact a patient's quality of life, and treatment should be focused on relieving these symptoms and improving overall well-being 1. Some key symptoms of microscopic colitis include:
- Frequent loose stools
- Abdominal pain
- Fatigue
- Weight loss
- Urgency
- Nighttime bowel movements
Treatment for microscopic colitis typically begins with lifestyle changes, such as avoiding NSAIDs, caffeine, alcohol, and artificial sweeteners that can trigger symptoms 1. Medications may also be prescribed, including:
- Anti-diarrheal agents like loperamide (2-4 mg as needed, up to 16 mg daily)
- Bismuth subsalicylate (two tablets three times daily for 8 weeks)
- Budesonide (9 mg daily for 6-8 weeks, then tapered) is the most effective prescription medication, with remission rates of 70-80% 1 Other options may include cholestyramine (4 g with meals), which binds bile acids, or immunosuppressants like azathioprine for severe cases 1. Regular follow-up with a gastroenterologist is recommended to monitor treatment effectiveness and adjust as needed 1. It's also important to note that microscopic colitis can be diagnosed through colonoscopy and biopsy, and that routine colonoscopy and biopsy may not be necessary in the evaluation of most patients with typical symptoms of IBS-D under the age of 50 years, but may be the only way to diagnose microscopic colitis in those with functional diarrhea 1.
From the Research
Symptoms of Microscopic Colitis
- Watery nonbloody diarrhea 2, 3, 4, 5, 6
- Nocturnal stools 2, 6
- Fecal urgency 2, 4, 6
- Abdominal pain 2, 3, 5, 6
- Arthralgias 2, 5
- Weight loss 2, 3, 4, 6
- Incontinence 3, 6
Treatment Options for Microscopic Colitis
- Elimination of offending medications highly associated with microscopic colitis 2
- Antidiarrheals such as loperamide for mild symptoms 2
- Budesonide for induction of clinical remission in moderate-severe disease 2, 3, 4, 5, 6
- Low-dose budesonide for maintenance therapy in patients with recurrent symptoms 2
- Immunomodulators such as azathioprine and 6-mercaptopurine for patients who fail or are intolerant to budesonide 3, 4
- Biologics such as infliximab and adalimumab for patients who fail or are intolerant to budesonide 3, 4