What is the Best Treatment for Microscopic Colitis?

The corticosteroid budesonide is the most effective treatment for patients with microscopic colitis (MC), according to a meta-analysis in the October issue of Clinical Gastroenterology and Hepatology. However, once patients stop taking this drug, the rate of symptom relapse is high.

MC is an inflammatory disorder of the colon that causes watery, non-bloody diarrhea, especially among older women. Its incidence has increased in recent years, approaching that of ulcerative colitis and Crohn’s disease.

Budesonide is a potent corticosteroid that is frequently used to treat MC, because it has less systemic absorption and fewer adverse effects than other steroids. However, budesonide is less efficacious than conventional steroids in the treatment of ulcerative colitis and Crohn’s disease. Michael J. Stewart and colleagues performed a meta-analysis of 8 clinical trials (236 patients) to evaluate the effects of corticosteroids for short- and long-term treatment of MC.

They found that budesonide was well-tolerated and effective for short- and long-term treatment of each subtype of MC (collagenous colitis and lymphocytic colitis). Patients were 3 times more likely to have a clinical response to a 6- to 8-week course of budesonide than to placebo, with no increase in risk for adverse events. The patients that received budesonide also had a much higher rate of histologic response (based on biopsy analysis). Another steroid, prednisolone, was not effective as a short-term therapy.

Although budesonide produced an impressive clinical response, 46%–80% of patients had symptom relapse within 6 months of discontinuing the drug. Stewart et al. state that further studies are required to determine how to achieve the maximal sustained effects of budesonide and how to withdraw or reduce the dosage, to minimize symptom relapse. They would also like to determine whether alternating courses of budesonide might better control symptoms and whether the addition of other therapies improves its effects.

The best strategy for patients with microscopic colitis is not clear—management has focused on treating associated conditions, such as celiac disease, avoiding certain dietary factors and medications, and treating the diarrhea symptoms. A number of pharmacologic and alternate therapies (including probiotics) have been used with varying degrees of success, but few randomized controlled trials have been performed. According to Stewart et al., there have been no controlled trials of commonly used immunosuppressive medications such as azathioprine or methotrexate as maintenance therapy for patients with unremitting disease.

More information on microscopic colitis:

Read the article online.
Stewart MJ, Seow CH, Storr MA. Prednisolone and budesonide for short- and long-term treatment of microscopic colitis: systematic review and meta-analysis. Clin Gastroenterol and Hepatol 2011; 9:881–890.

2 Comments

  1. Avatar
    Denise Davis December 31, 2011

    Do you have any information or research on malrotation or nonrotation of the intestines? Specifically adult malrotation. I am specifically interested in the treatment of the disorder. My daughter was taken to the ER for abdominal pain, diarrhea, vomiting 12/19/11. CT scan was ordered and the malrotation was discovered. Her small intestines are located on her right side and her large intestines are on the left. She was hospitalized and treated for dehydration, also her magnesium was low, so it was given also. The lab results of CBC w/Diff showed her hHgb was low 11.3, hRBC 3.47, hWBC 4.2, hMCV 100.9, hCalcium, Serum 8.0, hALK Phos 27, HCloride 110, hT.Protein 5.5 not sure if these lows and highs are significant to her condition. She had a XR UGI with Small Bowel which showed no evidence of midgut volvulus. The barium enema was incomplete study, but it did show diverticulosis of the splenic flexure and dystrophic linear calcification in the left hemipelvis. Should sugery be considered as a treatment for the malrotation ….she is 23 years old and has abdominal pain, nausea for the last three years, she had a cholecystectomy on Feb. 2009 and still has nausea and vomiting and diarrhea intermittently.

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    - December 25, 2012

    This website is great. I like it.(www.linkspirit.net)N_X_D_S.

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