From the Guidelines
Patients with microscopic colitis should be monitored for symptom improvement, medication side effects, and disease recurrence, with a focus on assessing stool frequency, consistency, and presence of abdominal pain every 2-4 weeks after starting treatment, as recommended by the American Gastroenterological Association institute guideline on the medical management of microscopic colitis 1. When treating microscopic colitis with budesonide, which is recommended over no treatment for the induction of clinical remission 1, it is essential to monitor for steroid-related side effects, including mood changes, insomnia, hyperglycemia, and adrenal suppression with longer use.
- Key aspects to monitor include:
- Symptom improvement, such as reduction in stool frequency and abdominal pain
- Medication side effects, particularly those associated with budesonide, such as steroid-related adverse effects
- Disease recurrence, which occurs in 30-60% of cases
- Laboratory monitoring should be performed regularly, including:
- Complete blood count
- Comprehensive metabolic panel
- Inflammatory markers like C-reactive protein or fecal calprotectin, every 3-6 months during active disease, then annually during remission
- Follow-up colonoscopy is generally not required unless symptoms change significantly or don't respond to therapy, as stated in the guideline 1.
- After achieving remission, patients should be monitored for recurrence, with more frequent follow-ups initially (every 3 months), extending to every 6-12 months with sustained remission, and educated to report any significant changes in symptoms promptly, given the relapsing-remitting course of microscopic colitis.
From the Research
Monitoring a Patient with Microscopic Colitis
To monitor a patient with microscopic colitis, the following aspects should be considered:
- Symptom severity: Monitor the severity of symptoms such as watery nonbloody diarrhea, nocturnal stools, fecal urgency, abdominal pain, arthralgias, and weight loss 2, 3, 4.
- Medication adherence: Ensure the patient is adhering to the prescribed treatment, which may include antidiarrheals, budesonide, or other medications 2, 5, 6.
- Potential adverse effects: Monitor for potential adverse effects of medications, such as those associated with budesonide or other immunomodulators 2, 6.
- Disease activity: Assess the disease activity and adjust treatment as needed to achieve clinical remission 6.
- Quality of life: Evaluate the impact of microscopic colitis on the patient's quality of life and adjust treatment accordingly 5, 4.
- Risk factors: Be aware of risk factors that may exacerbate the condition, such as certain medications, smoking, or underlying autoimmune conditions 2, 3.
Laboratory and Diagnostic Tests
The following laboratory and diagnostic tests may be used to monitor a patient with microscopic colitis:
- Histologic evaluation: Regular histologic evaluation to assess the severity of inflammation and monitor for changes in the colon 2, 4.
- Endoscopy: Endoscopy may be used to rule out other conditions or to assess the colon for any changes 2, 3.
- Stool tests: Stool tests may be used to monitor for changes in stool frequency, consistency, or weight 6.