Curr Treat Options Gastroenterol. 1999 Apr;2(2):127-133. doi: 10.1007/s11938-999-0040-3.
Lymphocytic and Collagenous Colitis: Medical Management.
Current treatment options in gastroenterology
Marshall, Irvine
Affiliations
Affiliations
- Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
PMID: 11096583
DOI: 10.1007/s11938-999-0040-3
Abstract
When possible, patients taking nonsteroidal anti-inflammatory medications should discontinue them when the diagnosis of microscopic colitis is made. Although there is no direct evidence of its efficacy, a trial of elimination of caffeine or lactose or both should be undertaken. Nonspecific antidiarrheal agents (eg, loperamide, diphenoxylate) may be administered, but appear to be largely ineffective in this population. An aminosalicylate should be initiated at full therapeutic dose (2 to 4 g daily) as the first-line therapy. Because sulfasalazine appears to be associated with a high incidence of adverse effects in patients with microscopic colitis, other derivatives of 5-aminosalicylate (5-ASA) are preferred. Bile salt-binding agents such as cholestyramine or colestipol appear to be effective alternatives for patients who are either unresponsive to or intolerant of aminosalicylates. Systemic corticosteroids are an effective treatment for microscopic colitis, but may offer only transient improvement in symptoms. Given their potential adverse effects, corticosteroids should be reserved for patients with refractory disease in whom aminosalicylates and bile salt-binding agents have failed. Other agents that may be effective include antibiotics, bismuth subsalicylate, budesonide, pentoxifylline, octreotide, and methotrexate. Although these agents can be considered in unusual cases, the cumulative clinical experience with them in this setting is relatively limited. Surgical intervention, with either fecal stream diversion or subtotal colectomy, shows promise as an intervention of last resort. In refractory cases of microscopic colitis, strong consideration should be given to excluding a concomitant diagnosis of celiac disease, bacterial overgrowth, or chronic infection.
References
- Gastroenterol Clin North Am. 1995 Sep;24(3):717-29 - PubMed
- Schweiz Med Wochenschr. 1993 Jul 31;123(30):1487-90 - PubMed
- Am J Gastroenterol. 1995 Sep;90(9):1394-400 - PubMed
- J Clin Gastroenterol. 1996 Dec;23(4):300-1 - PubMed
- Dis Colon Rectum. 1996 May;39(5):573-8 - PubMed
- Gut. 1992 Jan;33(1):65-70 - PubMed
- Pathol Eur. 1976;11(1):87-9 - PubMed
- Gut. 1996 Dec;39(6):846-51 - PubMed
- Gut. 1996 May;38(5):788-91 - PubMed
- Am J Gastroenterol. 1999 Jul;94(7):1871-5 - PubMed
- Gut. 1995 Jun;36(6):880-6 - PubMed
- Am J Surg Pathol. 1996 Sep;20(9):1102-9 - PubMed
- Mayo Clin Proc. 1995 May;70(5):430-3 - PubMed
- Dis Colon Rectum. 1984 Oct;27(10):672-6 - PubMed
- Gut. 1992 May;33(5):683-6 - PubMed
- Ann Pathol. 1996 Dec;16(6):430-4 - PubMed
- Gastroenterology. 1998 Jan;114(1):29-36 - PubMed
- J Intern Med. 1991 May;229(5):443-6 - PubMed
- Histopathology. 1996 Aug;29(2):101-10 - PubMed
- Gastroenterology. 1997 Jun;112(6):1830-8 - PubMed
- Gastroenterology. 1985 Mar;88(3):792-7 - PubMed
- Am J Gastroenterol. 1997 Jan;92(1):57-60 - PubMed
- Gastroenterology. 1995 Aug;109(2):449-55 - PubMed
- Gastroenterol Clin Biol. 1993;17(12):976-7 - PubMed
- Pathol Res Pract. 1990 Apr;186(2):303-6; discussion 306-8 - PubMed
- Am J Gastroenterol. 1998 Feb;93(2):270 - PubMed
- Am J Gastroenterol. 1997 Jul;92(7):1213-5 - PubMed
- Ital J Gastroenterol. 1996 Apr;28(3):147-51 - PubMed
- Aust N Z J Med. 1996 Feb;26(1):114 - PubMed
- Gastroenterology. 1986 Dec;91(6):1583-4 - PubMed
- Mayo Clin Proc. 1987 Aug;62(8):665-71 - PubMed
- Can J Gastroenterol. 1996 Nov-Dec;10(7):436-9 - PubMed
Publication Types