From the Guidelines
For microscopic colitis, you should consult a gastroenterologist, who specializes in digestive disorders. These specialists have the expertise to diagnose this condition through colonoscopy with biopsies and can develop an appropriate treatment plan, as recommended by the American Gastroenterological Association Institute guideline on the medical management of microscopic colitis 1. Your primary care physician can provide a referral to a gastroenterologist.
Key Considerations
- Treatment typically begins with anti-diarrheal medications like loperamide (Imodium) and may progress to anti-inflammatory medications such as budesonide (Entocort EC, typically 9mg daily for 6-8 weeks), mesalamine, or in some cases, immunosuppressants, with budesonide being the recommended first-line therapy for induction of clinical remission 1.
- Gastroenterologists can also help identify and eliminate potential triggers, such as certain medications (NSAIDs, PPIs) or dietary factors that may worsen symptoms.
- They will monitor your response to treatment and adjust as needed, since microscopic colitis can be chronic and may require ongoing management.
- Early consultation is important as proper treatment can significantly improve quality of life by reducing diarrhea, abdominal pain, and other symptoms associated with this inflammatory bowel condition.
Additional Recommendations
- For patients with recurrence of symptoms following discontinuation of induction therapy, maintenance therapy with budesonide is recommended to maintain clinical remission 1.
- Alternative therapies such as mesalamine, bismuth salicylate, or prednisolone may be considered in patients who have contraindications to budesonide or for whom cost is a determining factor 1.
From the Research
Consultation for Microscopic Colitis
To consult for microscopic colitis, the following professionals can be considered:
- Gastroenterologists: They play a crucial role in diagnosing and managing microscopic colitis, as they can refer patients for colonoscopy and guide treatment based on symptom severity 2, 3, 4.
- Endoscopists: They perform colonoscopies and take biopsy samples from the colonic mucosa, which are essential for diagnosing microscopic colitis 3.
- Pathologists: They examine the biopsy samples and use objective histological criteria to make a diagnosis of microscopic colitis 3.
Key Considerations for Consultation
When consulting these professionals, the following points should be considered:
- Effective communication among gastroenterologists, endoscopists, and pathologists is necessary for accurate diagnosis and management of microscopic colitis 3.
- A colonoscopy should be performed, even if the mucosa appears normal, to obtain biopsy samples for histological evaluation 3.
- Treatment options, such as antidiarrheals, budesonide, and immunomodulators, should be guided by the severity of symptoms and the patient's response to treatment 2, 4, 5.