From the Guidelines
Medications such as non-steroidal anti-inflammatory drugs (NSAIDs), proton pump inhibitors (PPIs), selective serotonin reuptake inhibitors (SSRIs), and others can cause microscopic colitis, and discontinuing the offending medication is often the first step in treatment. When considering the management of microscopic colitis, it is essential to weigh the benefits and risks of various medications, as some may exacerbate the condition. According to the American Gastroenterological Association institute guideline on the medical management of microscopic colitis 1, budesonide is recommended for the induction of clinical remission in patients with symptomatic microscopic colitis. Some key points to consider in the management of microscopic colitis include:
- The potential for certain medications to trigger or worsen microscopic colitis, including NSAIDs, PPIs, and SSRIs
- The importance of discontinuing the offending medication when possible, as this can lead to symptom improvement
- The use of budesonide as a first-line therapy for the treatment of microscopic colitis, due to its favorable risk/benefit profile and convenience of once-daily dosing, as supported by a meta-analysis of 6 randomized clinical trials 1
- The consideration of alternative therapies, such as mesalamine, for patients who do not respond to budesonide or have residual symptoms after treatment. It is crucial to consult a healthcare provider if symptoms of microscopic colitis develop, as they can provide guidance on the best course of treatment and help weigh the benefits and risks of various medications.
From the Research
Medication-Induced Microscopic Colitis
- Microscopic colitis (MC) is a chronic inflammatory bowel disease characterized by watery diarrhea, and its incidence is increasing 2, 3.
- Several medications have been associated with an increased risk of developing MC, including: + Nonsteroidal anti-inflammatory drugs (NSAIDs) 3, 4 + Proton pump inhibitors (PPIs) 2, 3, 4 + Selective serotonin reuptake inhibitors (SSRIs) 2, 3, 4 + Statins 2, 5
- However, some studies have found no association between these medications and MC, highlighting the need for further research 5, 6.
- The concomitant use of NSAIDs and PPIs has been shown to increase the risk of MC fivefold, suggesting a potential synergistic effect 4.
Mechanisms and Risk Factors
- The exact mechanisms by which medications induce MC are unclear, but acid suppression-related dysbiosis and NSAID-related side effects may contribute to the development of the disease 4.
- Other risk factors for MC include increasing age, female sex, and the presence of other autoimmune diseases 2.
- The clinical presentation of MC is nonspecific and includes watery nonbloody diarrhea, nocturnal stools, fecal urgency, abdominal pain, arthralgias, and weight loss 2.
Treatment and Management
- The approach to treatment is similar for both lymphocytic colitis and collagenous colitis and should be guided by the severity of the patient's symptoms 2.
- Offending medications highly associated with MC should be eliminated as clinically possible 2.
- Antidiarrheals, such as loperamide, are the initial choice for patients with mild symptoms, while budesonide is recommended for induction of clinical remission in patients with moderate to severe disease 2.