Materiały źródłowe

• #1 Microscopic colitis – Guts UK

  https://gutscharity.org.uk/advice-and-information/conditions/microscopic-colitis/

  Microscopic colitis can be treated for most people. The correct diagnosis and treatment can make a huge and dramatic difference to a person’s quality of life. There is no increased risk of cancer with a diagnosis of microscopic colitis. However, there is some data suggesting that without treatment some people do need to stay in hospital as an inpatient during a flare of symptoms. We don’t want anyone suffering in silence, so Guts UK wants to raise awareness of this easily overlooked condition and put the patient in control. […] Microscopic colitis can be treated with a course of gut specific steroids or with symptom-relieving medicines. Whilst these treatments work for most people, some people need further treatment or investigation. Because of this, there are ongoing studies to look at other treatment options including other drug therapies and modifying the microbiome too.

• #1 Microscopic colitis: What is it, and what are the treatment options? | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/91/4/215

  Microscopic colitis, an inflammatory disorder characterized by chronic diarrhea, is so named because its diagnosis requires histologic evaluation with mucosal biopsy. A standard approach to therapy improves symptoms and quality of life. […] First-line therapy for microscopic colitis, regardless of the subtype, is budesonide 9 mg/day for 8 weeks. If the patient is symptom-free after 8 weeks, budesonide therapy can be stopped. If the patient remains symptomatic at the end of 8 weeks or if symptoms recur, then budesonide can be continued or resumed at the lowest effective dose, usually 6 mg/day or less, for 6 to 12 months. Patients should be advised to avoid smoking and using nonsteroidal anti-inflammatory drugs. If possible, they should discontinue all associated medications, including proton pump inhibitors, statins, aspirin, immune checkpoint inhibitors, and selective serotonin reuptake inhibitors.

• #1 Microscopic colitis: a guide for general practice | British Journal of General Practice

  https://bjgp.org/content/71/702/41

  The initial treatment for most patients with microscopic colitis is oral budesonide at a dose of 9 mg/day for a period of 68 weeks; 81%84% of patients respond successfully to treatment compared with 36%43% given a placebo. […] Patients may enter and stay in remission at this point; however, some studies have shown that patients may need long-term budesonide (for at least 6 months) at 3 mg or 6 mg/day but this should be titrated according to clinical response. […] Prednisolone, loperamide, bismuth, mesalazine, antibiotics, or probiotics are not recommended treatments. […] Thiopurines or biologics may be used to treat patients who do not respond to budesonide. […] Treatment is with oral budesonide 9 mg/day for an initial period of 68 weeks.

• #1 Long-Term Budesonide for Microscopic Colitis Is Effective Maintenance Treatment

  https://www.gastroenterologyadvisor.com/news/long-term-budesonide-for-microscopic-colitis-is-effective-maintenance-treatment/

  Budesonide at the lowest effective dose is an efficacious maintenance therapy for microscopic colitis. […] Budesonide efficaciously controls moderate to severe symptoms of microscopic colitis (MC) with a low risk for adverse effects from long-term use. […] Budesonide is the first-line corticosteroid therapy recommended for individuals diagnosed with moderate to severe symptoms of MC. […] The researchers calculated a pooled clinical remission rate of 84% (95% CI, 0.60-1.00) using budesonide maintenance therapy compared with a clinical remission rate of 21% for placebo control groups in the randomized controlled trials. […] Following discontinuation of budesonide, MC relapses occurred at a pooled rate of 53% (95% CI, 0.42-0.63). This high risk of MC recurrence suggests that long-term budesonide maintenance therapy is required for continued quality of life and effective symptom control.

• #1 Management of microscopic colitis: challenges and solutions | CEG

  https://www.dovepress.com/management-of-microscopic-colitis-challenges-and-solutions-peer-reviewed-fulltext-article-CEG

  The overall goal in the management of MC is symptomatic improvement, the exact definition of which varies greatly between studies. A large population-based study has defined clinical remission as improvement in bowel movements to less than three per day or less than one watery stool daily over the course of 1 week. […] The 2016 AGA clinical guideline for the management of MC recommends that budesonide be used as first-line therapy. This is based on six randomized clinical trials showing clinical response and five showing histological response. […] Budesonide 9 mg/day for 68 weeks was effective in inducing both clinical and histologic remission. […] Despite the effectiveness of budesonide, relapse rates have been reported at 40%81% and can occur as soon as 2 weeks after cessation of therapy.

• #1 Microscopic Colitis Medications | Treatment & Management

  https://www.microscopiccolitisfoundation.org/using-medications.html

  But based on empirical evidence, it appears that patients with drug-induced MC may be the only subset of patients who are consistently able to enjoy long-term remission, without any continued treatment intervention. […] In many cases however, especially when symptoms have been active for many years, simply discontinuing the use of the drug may not be sufficient to establish and maintain remission. […] As part of their treatment recommendations, most gastroenterologists advise MC patients to avoid certain drugs that are known to be commonly associated with the onset of microscopic colitis. […] The first treatment regimen specifically developed for treating microscopic colitis was demonstrated approximately a couple of decades ago in a controlled trial, by a medical researcher who happened to have microscopic colitis himself, Dr. Kenneth Fine.

• #1 Microscopic Colitis: Treatment, Symptoms & What It Is

  https://my.clevelandclinic.org/health/diseases/17227-microscopic-colitis

  Microscopic colitis is a type of inflammatory bowel disease, a chronic condition of inflammation in your colon. Diet and medication can help manage flare-ups when they occur. […] While it’s a lifelong condition, it’s usually manageable with medical treatments. […] Treatment can vary depending on your symptoms and how severe they are. They range from dietary and lifestyle changes to over-the-counter and prescription medications. […] Common medications include: Bulking agents, such as psyllium, to make your poop more solid and slow down its transit time. Anti-diarrheals that slow down your bowel contractions, such as loperamide or diphenoxylate. Bismuth subsalicylate (Pepto Bismol) for diarrhea, acid reflux, nausea and indigestion. Budesonide, a corticosteroid that’s absorbed in your colon, where it reduces inflammation. Mesalamine, a medication designed to treat ulcerative colitis, for inflammation and pain. Bile acid sequestrants (colesevelam, colestipol), if you have bile acid malabsorption.

• #1

  https://www.asge.org/home/resources/key-resources/blog/view/practical-solutions/2023/09/27/case-9–microscopic-colitis

  Practical tip: Budesonide can be cost-prohibitive in some patients. In these situations, bismuth subsalicylate 262mg tablets can be used with a dose of three tablets by mouth three times per day. […] Relapse occurs in up to 80 percent of patients after tapering off initial therapy. Patients can be maintained on the lowest effective dose of budesonide chronically if needed.

• #1 Treating Microscopic Colitis

  https://consultqd.clevelandclinic.org/microscopic-colitis-what-is-it-and-what-are-the-treatment-options

  Some evidence supports the use of immunomodulators, including azathioprine and mercaptopurine, in the treatment of microscopic colitis. Biologic therapies such as antitumor necrosis factor agents infliximab or adalimumab or the anti-integrin antibody agent vedolizumab have shown some success. Data are emerging regarding Janus kinase inhibitors for treating microscopic colitis, but to date their efficacy is uncertain. Mesalamine compounds have not proven effective. The American Gastroenterological Association Institute guideline recommends mesalamine as a potential alternative to budesonide, but the European guidelines do not. […] Studies of probiotics have also generated little evidence to support their use in mitigating microscopic colitis. The Institute guideline and other authors recommend against the use of probiotics for microscopic colitis.

• #1 Diagnosis and Pharmacological Management of Microscopic Colitis in Geriatric Care

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10869377/

  Based on results from clinical studies, bismuth subsalicylate, a substance with antisecretory and anti-inflammatory properties, has been shown to reduce diarrhea in various diseases, including microscopic colitis, although its antidiarrheal mechanism is still not clarified. […] In recent years, tumor necrosis factor (TNF) inhibitors (infliximab and adalimumab), together with the 47 integrin inhibitor, vedolizumab, and more recently the anti-IL-12/IL-23 antibody, ustekinumab, have all been investigated in the management of microscopic colitis. […] Loperamide, a synthetic opioid that primarily affects intestinal opiate receptors to control diarrhea, has been studied for microscopic colitis in seven minor studies, five of which were retrospective cohorts. […] Cholestyramine (a bile acid-binding resin indicated to reduce diarrhea caused by bile acid malabsorption) may be used as a therapy for microscopic colitis or to decrease budesonide dependence in microscopic colitis.

• #1 Diagnosis and Pharmacological Management of Microscopic Colitis in Geriatric Care

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10869377/

  When symptoms are refractory and considerably affect the quality of life, thiopurines (azathioprine 22.5 mg/kg per day or mercaptopurine 11.5 mg/kg per day), which are antimetabolites of purines and immunomodulators, may be considered for the maintenance of clinical remission as a last resort both based on effectiveness, but also due to the risk of complications.

• #1

  https://journals.lww.com/ajg/fulltext/2021/10001/s934_the_use_of_biologics_in_patients_with.935.aspx

  Microscopic colitis (MC) is a cause of chronic watery diarrhea with associated symptoms including abdominal pain and weight loss. However, relapse rate is common after budesonide discontinuation, reported to be as high as 80%. Biologics such as anti-TNF and anti-integrins have recently been used for treatment of refractory MC with conflicting data regarding efficacy. […] Patients with refractory MC may be successfully treated with biologics and demonstrate good efficacy and safety.

• #1 Microscopic Colitis: Is Vedolizumab An Option? – Gastroenterology Advisor

  https://www.gastroenterologyadvisor.com/features/potential-of-vedolizumab-therapy-in-the-treatment-of-microscopic-colitis/

  Due to the relatively high relapse rate and need for additional therapies, current research is being done on the use of Vedolizumab for the treatment of microscopic colitis. […] The 2016 American Gastroenterological Association guidelines review detailed several treatment options for MC, including budesonide, mesalamine, cholestyramine, bismuth salicylate, probiotics, and prednisone. […] Based on the relatively high relapse rate and desire to limit prolonged use of budesonide (albeit, not a systemic steroid), there is a significant clinical need for additional treatment options. Vedolizumab (VDZ) is a monoclonal antibody against the 47 integrin found on T-cells that inhibits the migration of T-cells into the gastrointestinal tract. […] Although the developing data supporting the use of VDZ in MC does appear at least somewhat promising, there are many potential barriers to its use in real world settings. MC is considered an off-label indication for VDZ.

• #1 Microscopic colitis – Wikipedia

  https://en.wikipedia.org/wiki/Microscopic_colitis

  Lymphocytic and collagenous colitis have both been shown in randomized, placebo-controlled trials to respond well to budesonide, a glucocorticoid. Budesonide formulated to be active in the distal colon and rectum is effective for both active disease and in the prevention of relapse. However, relapse occurs frequently after withdrawal of therapy. […] Studies of a number of other agents including antidiarrheals, bismuth subsalicylate (Pepto-Bismol), mesalazine/mesalamine (alone or in combination with cholestyramine), systemic corticosteroids, cholestyramine, immunomodulators, and probiotics have shown to be less effective than budesonide for treating both forms of microscopic colitis. […] Anti-TNF inhibitors, split ileostomy, diverting ileostomy, and subtotal colectomy are options for management of steroid-dependent or refractory microscopic colitis. Currently, the need to resort to surgery is limited considering the improvement of drug therapy options. However, surgery is still considered for patients with severe, unresponsive microscopic colitis.

• #1 Microscopic colitis – IBD Clinic

  https://ibdclinic.ca/what-is-ibd/microscopic-colitis/

  Cholestyramine (Questran), a drug binding bile acids, may help Microscopic Colitis by removing bile acids that contribute to inflammation. […] In small studies azathioprine (or mercaptopurine) brought on remission in Microscopic Colitis and reduced the need for steroids. […] Anti-TNF drugs, which target proteins in the body involved in inflammation, may help Microscopic Colitis. […] While older publications have reported surgical approaches can successfully treat severe Microscopic Colitis, the development of more effective medications means surgery is now rarely required. […] It may also help to reduce your intake of caffeine and artificial sugars as they are known to draw fluid into the bowel that may aggravate diarrhea. […] The outlook for people with Microscopic Colitis is generally good. Four out of five can expect to be fully recovered within three years, with some even recovering without treatment.

• #1 Microscopic Colitis: Symptoms, Causes, Treatment & More

  https://www.health.com/microscopic-colitis-8631112

  Lifestyle and dietary changes can help manage microscopic colitis and reduce symptom frequency and severity. These modifications may include: […] Changing medication: If you take medications associated with microscopic colitis flares, your healthcare provider may switch you to an alternate medication. […] Avoiding smoking: Smoking can trigger or worsen intestinal inflammation. Talk to your healthcare provider about smoking cessation programs if you smoke and are ready to quit. […] Avoiding trigger foods: Caffeine, alcohol, and artificial sweeteners can worsen microscopic colitis symptoms. Avoid any other foods you might be sensitive to. For instance, if you are lactose intolerant, your healthcare provider may ask you to avoid dairy. They may ask you to avoid gluten if you have celiac disease or gluten intolerance. […] Staying hydrated: When you have chronic diarrhea, your body loses fluids and electrolytes. If you lose more fluids than you replace, you can become dehydrated. Drink plenty of fluids throughout the day to prevent dehydration.

• #1 Treating Microscopic Colitis

  https://consultqd.clevelandclinic.org/microscopic-colitis-what-is-it-and-what-are-the-treatment-options

  First-line therapy for microscopic colitis, regardless of the subtype, is budesonide 9 mg/day for eight weeks. If the patient is symptom-free after eight weeks, budesonide therapy can be stopped. If the patient remains symptomatic at the end of eight weeks or if symptoms recur, then budesonide can be continued or resumed at the lowest effective dose, usually 6 mg/day or less, for six to 12 months. Patients should be advised to avoid smoking and using nonsteroidal anti-inflammatory drugs. If possible, they should discontinue all associated medications, including proton pump inhibitors, statins, aspirin, immune checkpoint inhibitors and selective serotonin reuptake inhibitors. […] When budesonide therapy is unfeasible or ineffective, other treatment options include secondary medications such as the bile acid sequestrant cholestyramine, loperamide or bismuth salicylate, all with varying degrees of efficacy. Some authors note that starting loperamide with budesonide might augment symptomatic relief, but few studies suggest that this combination is superior to budesonide alone.

• #1 Microscopic Colitis and Diet: What to Eat, Avoid, and More

  https://www.healthline.com/health/microscopic-colitis-diet

  Theres no specific diet for people with microscopic colitis, but eating foods like plain rice, low fat dairy, and bananas may help symptoms. […] Treatment usually involves taking medication to help ease your symptoms. However, a healthcare professional may also recommend natural remedies, such as dietary changes. […] The BRAT diet may help slow down digestion and reduce the frequency of bowel movements. However, this diet should only be followed temporarily during a flare-up. […] Some researchers also believe that getting probiotics from a concentrated, well-tested product like VSL#3 may help with symptoms. […] Making dietary and lifestyle changes may help relieve symptoms of microscopic colitis. […] If these dont help ease your symptoms, speak with a healthcare professional. They could help develop a treatment plan that may include medications to: stop diarrhea and block bile acids, fight inflammation, suppress the immune system. […] In severe cases, a doctor may suggest surgery to remove a portion of your colon. However, this is very rare.

• #1 Lymphocytic Colitis | Saint Luke’s Health System

  https://www.saintlukeskc.org/health-library/lymphocytic-colitis

  Lymphocytic colitis is inflammation of your large intestine. It causes episodes of watery diarrhea and belly pain. […] Your healthcare provider may prescribe medicines and suggest diet changes to treat your condition. […] Your healthcare provider may give you antidiarrheal medicines. You may also need budesonide, mesalamine, bismuth subsalicylate, or cholestyramine if you still have symptoms. […] Most people only need to take medicines for a short time. The majority of people respond well to medicines. If your symptoms come back, you might need to start taking these medicines again for a short time. […] You may need to stay away from foods that make your diarrhea worse. These can include dairy products, caffeine, artificial sweeteners, and foods high in fat. Some people with this condition also do well on a gluten-free diet especially if they also have celiac disease.

• #1 BATTLING MICROSCOPIC COLITIS: PROGNOSIS, TYPES, PREVENTION, AND TREATMENT | Mya Care

  https://myacare.com/blog/battling-microscopic-colitis-prognosis-types-prevention-and-treatment

  Making changes to your diet can also help to manage symptoms of microscopic colitis. While there is no specific microscopic colitis diet, a few common suggestions include: Avoiding foods that initiate inflammation in the colon, such as spicy foods, caffeine, and alcohol. Removing gluten from the diet. Moderating high-fat food and salt intake, as it can be difficult for those with microscopic colitis to absorb fats or salt. Increasing the consumption of stool-bulking foods and supplements, such as psyllium husk. Eating smaller, more frequent meals. Staying hydrated helps control diarrhea. Occasional fasting may help to improve symptoms in some patients. Similarly to those with IBS, a third of people with microscopic colitis might benefit from a low FODMAP diet to ease symptoms of IBS. FODMAPs are highly fermentable, prebiotic carbohydrates that may worsen symptoms in those with IBS. Official guidelines strongly recommend avoiding the use of probiotics. There is limited evidence to support their long-term use in improving stool frequency and consistency in those with microscopic colitis. It is highly advisable to consult with a qualified specialist who can devise a suitable dietary plan tailored to your individual needs.

• #1 Microscopic Colitis: Treatment, Symptoms & What It Is

  https://my.clevelandclinic.org/health/diseases/17227-microscopic-colitis

  If you don’t respond to the above medications, and if your doctor believes there is an autoimmune factor involved, they might suggest additional medications to target your immune response, such as: Immunosuppressants. TNF inhibitors (adalimumab, infliximab). Cromolyn sodium to target mast cells (mastocytic enterocolitis). Low dose naltrexone. […] Your doctor may suggest: Eliminating common triggers. […] To manage flare-ups, some healthcare providers recommend a gastrointestinal soft diet, which is made up of low fat and low fiber foods. […] The Mediterranean diet is a good example of a diet that promotes anti-inflammatory foods. […] Microscopic colitis is still not well understood. […] Fortunately, the treatments we have often work to manage it.

• #1 Microscopic colitis diet: Foods to eat and avoid

  https://www.medicalnewstoday.com/articles/323026

  Drinking plenty of water or other liquids during episodes of MC is essential. The body loses fluids during episodes of diarrhea, which can lead to dehydration. Drinking enough water is also essential for many bodily functions, including digestive processes. […] A doctor or dietitian can also recommend a diet plan to suit an individuals needs according to their symptoms. For example, if a person has fatty or oily stools, a doctor may recommend a low fat diet. […] Doctors may recommend a low fiber diet to help manage diarrhea for people with MC. Fiber aids the passage of food through the digestive system. In some people, a low fiber diet may relieve diarrhea symptoms during an episode of MC. […] A person with MC needs to consult a doctor for a blood test to rule out celiac disease. There is no cure for celiac disease, but a gluten-free diet will help minimize or prevent symptoms.

• #1 Microscopic colitis: What is it, and what are the treatment options? | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/91/4/215

  With effective treatment, symptoms and quality of life improve with microscopic colitis. Predictions of sustained remission vary widely among studies. Although remission occurs for many patients, in most, the typical disease course is chronic or relapsing. As a general rule, continued budesonide therapy may be indicated for patients who are not in remission after 6 to 12 months. The goal of continued treatment is clinical (ie, symptomatic) remission.

• #1 Microscopic Colitis: An Underestimated Disease of Growing Importance

  https://www.mdpi.com/2077-0383/13/19/5683

  Once remission has been achieved, maintenance therapy should be initiated. The recommended treatment regimen is 6 mg of budesonide per day for a period of six months. […] The effectiveness of budesonide enemas in the treatment of chronic collagenous colitis (CC) was also investigated. […] The studies revealed that approximately 66–76% of cases achieved remission following BAS treatment. […] The potential use of anti-TNF-α (anti-tumour necrosis factor) biologic drugs in the treatment of MC is being explored given that the inhibition of TNF-α has been demonstrated to reduce the expression of acute phase proteins and associated inflammation. […] Thiopurines (azathioprine and mercaptopurine) represent the most extensively researched pharmacological agents for the management of MC in patients exhibiting an inadequate response to budesonide. […] In accordance with the UEG and EMCG guidelines, curative surgery should be employed as a last-resort treatment option in cases where pharmacological intervention has failed to elicit a response.

• #1 Microscopic Colitis (Collagenous and Lymphocytic Colitis) Treatment & Management: Approach Considerations, Medical Care

  https://emedicine.medscape.com/article/180664-treatment

  United European Gastroenterology (UEG) and the European Microscopic Colitis Group (EMCG) recommend the following for treatment of microscopic colitis (MC) : For induction of remission in collagenous colitis (CC) or lymphocytic colitis (LC): Oral budesonide […] Oral budesonide is effective for maintaining remission in patients with collagenous colitis; it is suggested for maintaining remission in patients with lymphocytic colitis […] Budesonide in microscopic colitis is not associated with an increased risk of serious adverse events […] The risk of osteoporotic bone fractures does not appear to be increased in patients with microscopic colitis who are treated with budesonide; however, there may be an associated reduction in bone mineral density with prolonged use […] Mesalazine therapy is not recommended for induction of remission in patients with microscopic colitis. No studies exist for maintenance

• #1 Microscopic colitis – IBD Clinic

  https://ibdclinic.ca/what-is-ibd/microscopic-colitis/

  Microscopic Colitis is an inflammatory bowel disease that affects the large bowel (colon and rectum) and was first recognized by doctors 40 years ago. […] This web page provides a brief overview of Microscopic Colitis, including diagnosis, possible causes, and treatments. […] There is little guidance on how to manage Microscopic Colitis. Over one-third of people with Microscopic Colitis find that their symptoms stop without the need for treatment. An important first step is to eliminate factors that could be contributing to diarrhea. If you are taking any of the drugs mentioned previously as possible triggers for Microscopic Colitis, then you may be asked to change or decrease the medication. […] If none of the steps mentioned above has improved your symptoms, you might need to take medication for your Microscopic Colitis. The main goal of treatment is to achieve clinical remission (freedom from symptoms) and improve the quality of life.

• #1 Microscopic Colitis: Symptoms, Causes, Treatment

  https://resources.healthgrades.com/right-care/digestive-health/microscopic-colitis

  Some home remedies may make symptoms of microscopic colitis go away. They include: […] Your doctor may also recommend: […] corticosteroids, such as budesonide (Pulmicort), to reduce inflammation […] bulk-forming laxatives, such as psyllium (Metamucil), to make stool softer and easier to pass […] immunosuppressants, such as TNF inhibitors (adalimumab, infliximab), to reduce atypical immune activity […] anti-diarrheal medicines, such as loperamide (Imodium), to reduce the number of bowel movements and make your stool less watery. […] In many cases, microscopic colitis goes away with treatment. However, it may persist for months or even years. […] For the best outcome, follow your doctor’s treatment plan. […] You may be able to treat microscopic colitis at home. Try drinking lots of water and consuming more easy-to-digest foods. Also, try avoiding alcohol, caffeine, and high sugar drinks. […] Be sure to seek medical treatment if your symptoms persist.

• #1 Microscopic Colitis – Nacogdoches Gastroenterology

  https://nacogdochesgastroenterology.com/page-view.php?id=30

  Other medications used to treat microscopic colitis include mesalamine and cholestyramine (Questran). […] People with microscopic colitis generally achieve relief through treatment, although relapses can occur. Some patients require long-term therapy because they experience prompt relapse when treatment is stopped. Unlike other forms of IBD, microscopic colitis usually does not progress to other IBD-related problems, such as arthritis, bowel obstruction, or colon cancer.

• #1 SciELO Brazil – DIAGNOSIS AND TREATMENT OF MICROSCOPIC COLITIS: POSITION PAPER ON BEHALF OF THE BRAZILIAN FEDERATION OF GASTROENTEROLOGY DIAGNOSIS AND TREATMENT OF MICROSCOPIC COLITIS: POSITION PAPER ON BEHALF OF THE BRAZILIAN FEDERATION OF GASTROENTEROL

  https://www.scielo.br/j/ag/a/tPZKRdCPbYCzSSxdgHZfwKL/

  Budesonide is the first-line treatment for inducing remission in most patients. However, alternatives such as immunosuppressants and biologics are available for those who are refractory to or intolerant of budesonide. […] Presently, the FDA and ANVISA has not approved any therapies for the treatment of MC, while the European Medicines Agency has approved oral budesonide as a treatment option. […] The primary step in managing patients with MC is to assess for factors that may worsen diarrhea, such as certain dietary elements (lactose, artificial sweeteners) and medications associated with diarrhea or trigger MC. Although adjusting these factors can improve symptoms, most patients will require pharmacological therapy to achieve full remission. Evidence suggests that both subtypes of MC respond similarly to medical treatments.

• #1 Treatment for Microscopic Colitis – NIDDK

  https://www.niddk.nih.gov/health-information/digestive-diseases/microscopic-colitis/treatment

  To treat microscopic colitis, your doctor may recommend quitting smoking, if you smoke […] changing any medicines you take that could be causing microscopic colitis or making your symptoms worse […] taking medicines to treat microscopic colitis […] changing what you eat and drink to help improve symptoms. Medicines most often treat microscopic colitis effectively. In rare cases, doctors may recommend surgery. Doctors prescribe medicines to improve symptoms and achieve remission a time when you have fewer symptoms or symptoms disappear. Medicines that doctors recommend to treat microscopic colitis include corticosteroids, also called steroids, most commonly in the form of budesonide […] aminosalicylates […] antidiarrheal medicines […] bile acid binders […] immunosuppressants […] biologics. Doctors rarely recommend surgery to treat microscopic colitis. Surgery may be an option if microscopic colitis causes severe symptoms that don’t improve after treatment with medicines.

• #2 Microscopic colitis – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/3000315

  Treatment aims to achieve clinical remission (3 stools per day and 1 watery stool per day) and improve quality of life. Drug choice depends on the severity and extent of disease and includes antidiarrheals, bismuth subsalicylate, oral budesonide, bile acid sequestrants, and immunosuppressants or biologic agents. […] Despite high rates of response to medical treatment, the relapse rate after discontinuation is 60% to 80% of patients with variable time to relapse. In patients with recurrent disease, consider re-treatment with prior therapies or with biologics for patients with severe refractory symptoms.

• #2 Microscopic colitis: diagnosis and management | Frontline Gastroenterology

  https://fg.bmj.com/content/10/4/388

  Microscopic colitis (MC) is a common cause of chronic, non-bloody, watery diarrhoea in older patients. […] Several treatment options exist, but budesonide is the only treatment proven in randomised-controlled trials to be effective and safe for induction and maintenance of remission.

• #2 Management of microscopic colitis: challenges and solutions | CEG

  https://www.dovepress.com/management-of-microscopic-colitis-challenges-and-solutions-peer-reviewed-fulltext-article-CEG

  The overall goal in the management of MC is symptomatic improvement, the exact definition of which varies greatly between studies. A large population-based study has defined clinical remission as improvement in bowel movements to less than three per day or less than one watery stool daily over the course of 1 week. […] The 2016 AGA clinical guideline for the management of MC recommends that budesonide be used as first-line therapy. This is based on six randomized clinical trials showing clinical response and five showing histological response. […] Budesonide 9 mg/day for 68 weeks was effective in inducing both clinical and histologic remission. […] Despite the effectiveness of budesonide, relapse rates have been reported at 40%81% and can occur as soon as 2 weeks after cessation of therapy.

• #2 Treating Microscopic Colitis

  https://consultqd.clevelandclinic.org/microscopic-colitis-what-is-it-and-what-are-the-treatment-options

  First-line therapy for microscopic colitis, regardless of the subtype, is budesonide 9 mg/day for eight weeks. If the patient is symptom-free after eight weeks, budesonide therapy can be stopped. If the patient remains symptomatic at the end of eight weeks or if symptoms recur, then budesonide can be continued or resumed at the lowest effective dose, usually 6 mg/day or less, for six to 12 months. Patients should be advised to avoid smoking and using nonsteroidal anti-inflammatory drugs. If possible, they should discontinue all associated medications, including proton pump inhibitors, statins, aspirin, immune checkpoint inhibitors and selective serotonin reuptake inhibitors. […] When budesonide therapy is unfeasible or ineffective, other treatment options include secondary medications such as the bile acid sequestrant cholestyramine, loperamide or bismuth salicylate, all with varying degrees of efficacy. Some authors note that starting loperamide with budesonide might augment symptomatic relief, but few studies suggest that this combination is superior to budesonide alone.

• #2 Microscopic Colitis: Dr. Falk Pharma international

  https://drfalkpharma.com/en/indications/microscopic-colitis/

  Targeted medications are available to treat microscopic colitis. The goal of this treatment is to alleviate the symptoms of the disease, or even to eliminate them entirely, so that patients experience a better quality of life for a long time. […] Very positive outcomes are common with budesonide, an active ingredient that belongs to the group of corticosteroids (sometimes simply called steroids). Budesonide in formulations designed for the treatment of gastroenterological diseases only becomes released and active in the large intestine themselves, where it has anti-inflammatory effects. It is then broken down in the liver. These features give the agent a high degree of effectiveness while keeping the side effects lower than conventional systemic (meaning active in the entire body) corticosteroids. The drug can be taken in several different oral forms which deliver the active ingredient specifically to the intestines. Budesonide is currently the only agent that is approved for the treatment of microscopic colitis.

• #2 Microscopic colitis: Common cause of unexplained nonbloody diarrhea

  https://www.wjgnet.com/2150-5330/full/v5/i1/48.htm

  Although effective in the short-term, all trials showed a high rate (61%-80%) of relapse within 2 wk of budesonide cessation. […] Immunosuppressive therapy with azathioprine or methotrexate has been utilized in patients either refractory to corticosteroid therapy or corticosteroid dependent, but there are no randomized controlled trials to guide therapy with these medications. […] When medical therapy was unsuccessful and symptoms were very severe, surgical interventions, such as a temporary or permanent loop ileostomy or even a proctocolectomy, have been employed in smaller case series. […] To conclude, the term microscopic colitis is now used to describe both lymphocytic and collagenous colitis and the condition should be kept in mind in any patient with unexplained watery nonbloody diarrhea with normal endoscopic findings.

• #2 Diagnosis and Pharmacological Management of Microscopic Colitis in Geriatric Care

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10869377/

  No therapeutic differences exist in the management of collagenous and lymphocytic colitis, and based on evidence from several clinical trials, budesonide is considered the drug of choice for the management of microscopic colitis, including its incomplete form. […] Alternatives to budesonide with antidiarrheal or immunomodulatory drugs (including biologics), such as bismuth subsalicylate, biologics, loperamide, bile acid sequestrants, and thiopurines, may be trialed for patients with troublesome microscopic colitis (those who are intolerant or fail to respond to budesonide and those who develop marked adverse events to this therapy), or as maintenance therapy to avoid any side effects of glucocorticoids. […] Based on a recent systematic review and meta-analysis conducted until April 2023, alternatives to budesonide are comparable to those reported in clinical trials.

• #2 Lymphocytic Colitis | Saint Luke’s Health System

  https://www.saintlukeskc.org/health-library/lymphocytic-colitis

  Lymphocytic colitis is inflammation of your large intestine. It causes episodes of watery diarrhea and belly pain. […] Your healthcare provider may prescribe medicines and suggest diet changes to treat your condition. […] Your healthcare provider may give you antidiarrheal medicines. You may also need budesonide, mesalamine, bismuth subsalicylate, or cholestyramine if you still have symptoms. […] Most people only need to take medicines for a short time. The majority of people respond well to medicines. If your symptoms come back, you might need to start taking these medicines again for a short time. […] You may need to stay away from foods that make your diarrhea worse. These can include dairy products, caffeine, artificial sweeteners, and foods high in fat. Some people with this condition also do well on a gluten-free diet especially if they also have celiac disease.

• #2 Diagnosis and Pharmacological Management of Microscopic Colitis in Geriatric Care

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10869377/

  Based on results from clinical studies, bismuth subsalicylate, a substance with antisecretory and anti-inflammatory properties, has been shown to reduce diarrhea in various diseases, including microscopic colitis, although its antidiarrheal mechanism is still not clarified. […] In recent years, tumor necrosis factor (TNF) inhibitors (infliximab and adalimumab), together with the 47 integrin inhibitor, vedolizumab, and more recently the anti-IL-12/IL-23 antibody, ustekinumab, have all been investigated in the management of microscopic colitis. […] Loperamide, a synthetic opioid that primarily affects intestinal opiate receptors to control diarrhea, has been studied for microscopic colitis in seven minor studies, five of which were retrospective cohorts. […] Cholestyramine (a bile acid-binding resin indicated to reduce diarrhea caused by bile acid malabsorption) may be used as a therapy for microscopic colitis or to decrease budesonide dependence in microscopic colitis.

• #2 Microscopic Colitis: Symptoms, Causes, Treatment & More

  https://www.health.com/microscopic-colitis-8631112

  Antidiarrheals: These medicines control diarrhea by slowing the muscle contractions that move bowel contents. Antidiarrheals include Imodium (loperamide), Pepto Bismol (bismuth subsalicylate), and Lomotil (diphenoxylate). […] Corticosteroids: Entocort (budesonide) is an oral corticosteroid that reduces inflammation in the colon. Most providers prescribe this for short-term use (around eight weeks) long enough for many people with microscopic colitis to achieve remission. If symptoms return after that, your healthcare provider may prescribe a lower dose for long-term use. […] Bile acid binders: Some people with microscopic colitis may experience a build-up of bile in the intestines, leading to diarrhea. Bile acid binders, such as cholestyramine (sold under brand names like Prevalite and Questran Light), can help reduce this buildup.

• #2 Microscopic Colitis: Symptoms, Causes, Treatment

  https://resources.healthgrades.com/right-care/digestive-health/microscopic-colitis

  Some home remedies may make symptoms of microscopic colitis go away. They include: […] Your doctor may also recommend: […] corticosteroids, such as budesonide (Pulmicort), to reduce inflammation […] bulk-forming laxatives, such as psyllium (Metamucil), to make stool softer and easier to pass […] immunosuppressants, such as TNF inhibitors (adalimumab, infliximab), to reduce atypical immune activity […] anti-diarrheal medicines, such as loperamide (Imodium), to reduce the number of bowel movements and make your stool less watery. […] In many cases, microscopic colitis goes away with treatment. However, it may persist for months or even years. […] For the best outcome, follow your doctor’s treatment plan. […] You may be able to treat microscopic colitis at home. Try drinking lots of water and consuming more easy-to-digest foods. Also, try avoiding alcohol, caffeine, and high sugar drinks. […] Be sure to seek medical treatment if your symptoms persist.

• #2 Microscopic colitis: Etiopathology, diagnosis, and rational management | eLife

  https://elifesciences.org/articles/79397

  In recent years, TNF inhibitors (infliximab and adalimumab) have been introduced for the management of microscopic colitis, together with the anti-integrin, vedolizumab and recently the anti-IL-12/IL-23 antibody, ustekinumab. […] Additional agents may be trialed as alternatives. However, some of these drugs are less well-studied, and they were not all recommended by the latest European guidelines for the management of microscopic colitis. […] Prednisolone is not recommended for use in microscopic colitis as current research suggests that it is less effective than budesonide for both collagenous and lymphocytic colitis. […] Mesalazine is not recommended as a therapeutic option. […] Data on the role of surgery are limited to isolated case reports and should be regarded as the ultimate treatment option to be reserved for patients with a disease course refractory to all other medical therapies or when effective medication cannot be tolerated.

• #2 Microscopic colitis: Etiopathology, diagnosis, and rational management | eLife

  https://elifesciences.org/articles/79397

  As recurrence is a frequent phenomenon after a short-term budesonide therapy, maintenance therapy may be considered. […] In case patients with microscopic colitis fail to respond to budesonide to induce and maintain clinical remission, and in those who develop significant side effects, additional therapies, such as loperamide, bile acid sequestrants, bismuth subsalicylate, thiopurines, and biologicals, may be considered. […] Bismuth subsalicylate, having antisecretory and anti-inflammatory properties, reduces diarrhea in microscopic colitis. […] When symptoms are truly refractory and considerably impact the quality of life, immunomodulating therapy with thiopurines (i.e., azathioprine or mercaptopurine) for maintenance of clinical remission may be initiated, but as the onset of action is delayed, thiopurines are not indicated as induction therapy.

• #2 Treating Microscopic Colitis

  https://consultqd.clevelandclinic.org/microscopic-colitis-what-is-it-and-what-are-the-treatment-options

  Some evidence supports the use of immunomodulators, including azathioprine and mercaptopurine, in the treatment of microscopic colitis. Biologic therapies such as antitumor necrosis factor agents infliximab or adalimumab or the anti-integrin antibody agent vedolizumab have shown some success. Data are emerging regarding Janus kinase inhibitors for treating microscopic colitis, but to date their efficacy is uncertain. Mesalamine compounds have not proven effective. The American Gastroenterological Association Institute guideline recommends mesalamine as a potential alternative to budesonide, but the European guidelines do not. […] Studies of probiotics have also generated little evidence to support their use in mitigating microscopic colitis. The Institute guideline and other authors recommend against the use of probiotics for microscopic colitis.

• #2 STELARA – Use of STELARA in the Treatment of Adult Patients with Microscopic Colitis

  https://www.jnjmedicalconnect.com/products/stelara/medical-content/stelara-use-of-stelara-in-the-treatment-of-adult-patients-with-microscopic-colitis

  Summarized in this response are relevant data from retrospective studies and case reports that describe the use of STELARA in the treatment of adult patients with microscopic colitis (MC; collagenous or lymphocytic). […] Data on the use of STELARA in the treatment of adult patients with MC is available through several retrospective studies. […] Additional data on the use of STELARA in the treatment of adult patients with MC is available through case reports. […] The patient was then treated with adalimumab, vedolizumab, and STELARA 90 mg q8w, without meaningful improvement. […] After 2 years of vedolizumab treatment, the patient was switched to STELARA (initial infusion followed by 90 mg q8w) plus daily budesonide 9 mg as the frequency of daily loose stools became difficult to maintain, along with an increase in inflammatory markers.

• #2 Management of microscopic colitis: challenges and solutions | CEG

  https://www.dovepress.com/management-of-microscopic-colitis-challenges-and-solutions-peer-reviewed-fulltext-article-CEG

  Its use in MC (specifically CC) has been examined in one case report of a patient refractory to budesonide who received three fecal transplants and achieved remission after the third for 11 months. […] The role of surgical management in MC is diminishing with considerable improvement and efficacy of available medical therapy.

• #2 Microscopic Colitis

  https://www.gihealth.com/colon/microscopic-colitis

  Budesonide has been very effective in controlling symptoms of microscopic colitis but does not cure the disease. The recurrence rate is relatively high, requiring additional therapy courses as needed. […] An alternative therapy to budesonide would be Pepto-Bismol (bismuth subsalicylate), taking three tablets 3 times daily for eight weeks. […] Medications to absorb excess bile, so-called bile salt sequestrants such as cholestyramine, are often prescribed to minimize symptoms. […] In very severe refractory cases, more powerful immunosuppressive and biologic drugs have been used with varying success. […] The role of surgical management in microscopic colitis has lessened since budesonide became available. Surgery still has a role in severe and unresponsive cases.

• #2 BATTLING MICROSCOPIC COLITIS: PROGNOSIS, TYPES, PREVENTION, AND TREATMENT | Mya Care

  https://myacare.com/blog/battling-microscopic-colitis-prognosis-types-prevention-and-treatment

  Making changes to your diet can also help to manage symptoms of microscopic colitis. While there is no specific microscopic colitis diet, a few common suggestions include: Avoiding foods that initiate inflammation in the colon, such as spicy foods, caffeine, and alcohol. Removing gluten from the diet. Moderating high-fat food and salt intake, as it can be difficult for those with microscopic colitis to absorb fats or salt. Increasing the consumption of stool-bulking foods and supplements, such as psyllium husk. Eating smaller, more frequent meals. Staying hydrated helps control diarrhea. Occasional fasting may help to improve symptoms in some patients. Similarly to those with IBS, a third of people with microscopic colitis might benefit from a low FODMAP diet to ease symptoms of IBS. FODMAPs are highly fermentable, prebiotic carbohydrates that may worsen symptoms in those with IBS. Official guidelines strongly recommend avoiding the use of probiotics. There is limited evidence to support their long-term use in improving stool frequency and consistency in those with microscopic colitis. It is highly advisable to consult with a qualified specialist who can devise a suitable dietary plan tailored to your individual needs.

• #2 Microscopic Colitis (Collagenous and Lymphocytic Colitis) Treatment & Management: Approach Considerations, Medical Care

  https://emedicine.medscape.com/article/180664-treatment

  Medical treatment is not different for different subtypes of microscopic colitis (MC). Similar responses to treatment have been reported throughout the literature […] Patients are also advised to avoid any offending medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), proton pump inhibitors (PPIs), and selective serotonin reuptake inhibitors (SSRIs) if a chronological relationship is established or if symptoms persist in spite of treatment […] Antidiarrheal agents such as loperamide may be used in mild cases ( 3 stools per day) or in conjunction with other therapies for symptomatic relief […] The treatment algorithm is as follows: First line: Budesonide 9 mg daily for at least 8 weeks. Once symptom remission has been achieved, patients can be gradually tapered off budesonide. If no recurrence of symptoms occurs, no maintenance therapy is needed. If patients develop recurrent symptoms after stopping budesonide, they can go on maintenance therapy with the lowest effective dose of budesonide: 3-6 mg daily for 6-12 months

• #2 Microscopic Colitis: Dr. Falk Pharma international

  https://drfalkpharma.com/en/indications/microscopic-colitis/

  According to studies, treatment with budesonide at a dosage of 9 mg daily leads to a major reduction in stool frequency after about 2 weeks, in many cases with no more diarrhea at all (remission), in about 80% of patients. […] However, the disease and the symptoms return within a few months for most patients if they stop taking the drug once their original symptoms go away. If this happens, guidelines recommend repeating induction therapy at 9 mg budesonide to achieve remission again, then lowering the dose to 3 to 6 mg daily. […] With microscopic colitis, is not necessary to switch to a special diet. However, it is important to eat a varied and balanced diet as is typically recommended by nutrition experts. Tests should also be performed to determine whether a microscopic colitis patient might also have gluten intolerance (celiac disease), since people with one of these conditions often have the other one as well. […] Smoking is known to have a negative impact on the course of the disease. Therefore, smokers who are diagnosed with microscopic colitis should quit.

• #2 Management of microscopic colitis: challenges and solutions | CEG

  https://www.dovepress.com/management-of-microscopic-colitis-challenges-and-solutions-peer-reviewed-fulltext-article-CEG

  Microscopic colitis (MC) is a chronic inflammatory bowel disease characterized by nonbloody diarrhea in the setting of normal appearing colonic mucosa. MC has two main subtypes based on histopathologic features, collagenous colitis and lymphocytic colitis. Management of both subtypes is the same, with treatment goal of reducing the number of bowel movements and improving consistency. First-line treatment involves counseling the patient about decreasing their risk factors, like discontinuing smoking and avoiding medications with suspected association such as NSAIDs, proton pump inhibitor, ranitidine, and sertraline. Starting loperamide for immediate symptomatic relief is used as an adjunct to therapy with glucocorticoids. Budesonide is considered first-line treatment for MC given its favorable side effect profile and good efficacy, though relapse rates are high. Systemic glucocorticoids should be reserved to patients unable to take budesonide. In glucocorticoid refractory disease, medications that have been tried include cholestyramine, bismuth salicylate, antibiotics, probiotics, aminosalicylates, immunomodulators, and anti-tumor necrosis factor-alpha inhibitors. More research is needed for the creation of a systematic stepwise approach for relapsing and refractory disease.

• #2 Microscopic Colitis And Diet: Beginner’s Guide To Treatment | Diet vs Disease

  https://www.dietvsdisease.org/microscopic-colitis-and-diet/

  Treatment is the same for both LC and CC. Anti-inflammatory medication has proven most effective, while over-the-counter antidiarrheals like Pepto-Bismol can also help ease symptoms. […] The above treatments may help relieve microscopic colitis in the short-term, but the most effective way to manage your symptoms is through diet and lifestyle. […] You may also want to try avoiding gluten, and possibly lactose (found in dairy). […] The good news is you can easily manage your microscopic colitis. […] While there is no cure, prescription medications and over-the-counter antidiarrheals like Pepto-Bismol can help ease symptoms. […] Natural supplements including probiotics and boswellia serrata extract may also resolve diarrhea, though more research is needed. […] Ultimately, relief from your symptoms is very possible.

• #2 Microscopic Colitis: Symptoms, Causes, Treatment & More

  https://www.health.com/microscopic-colitis-8631112

  Lifestyle and dietary changes can help manage microscopic colitis and reduce symptom frequency and severity. These modifications may include: […] Changing medication: If you take medications associated with microscopic colitis flares, your healthcare provider may switch you to an alternate medication. […] Avoiding smoking: Smoking can trigger or worsen intestinal inflammation. Talk to your healthcare provider about smoking cessation programs if you smoke and are ready to quit. […] Avoiding trigger foods: Caffeine, alcohol, and artificial sweeteners can worsen microscopic colitis symptoms. Avoid any other foods you might be sensitive to. For instance, if you are lactose intolerant, your healthcare provider may ask you to avoid dairy. They may ask you to avoid gluten if you have celiac disease or gluten intolerance. […] Staying hydrated: When you have chronic diarrhea, your body loses fluids and electrolytes. If you lose more fluids than you replace, you can become dehydrated. Drink plenty of fluids throughout the day to prevent dehydration.

• #2 Collagenous colitis and lymphocytic colitis | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/collagenous-colitis-and-lymphocytic-colitis

  There is no cure, but dietary changes and medical treatment, including drugs, can manage the symptoms in most cases. […] There is no cure, but treatment can manage the symptoms. Treatment options depend on the severity of the symptoms, but may include: […] Dietary changes some foods and drinks aggravate diarrhoea. Your doctor may advise you to cut down on fatty or spicy foods, milk products, alcohol, sugary drinks and caffeine. […] Anti-diarrhoea medication this slows the passage of faeces through the colon. […] Other medications if the above measures dont seem to help, your doctor may suggest stronger medications such as corticosteroids to help ease the symptoms. Non-absorbable steroids (budesonide) often help. Medications containing 5-aminosalicylic acid (5ASAs) may also help.

• #2 Microscopic Colitis

  https://www.gihealth.com/colon/microscopic-colitis

  As microscopic colitis is a non-destructive form of colitis, the overall goal of treatment is symptomatic improvement. The need for therapy depends on the severity of symptoms. […] Some patients find that dietary adjustments can help minimize symptoms, including the FODMAP diet. Smoking cessation and medication review may also be helpful. Some benefit from simple anti-diarrheal therapy, such as Imodium (loperamide), which is safe for long-term use up to 16 mg daily. The most common drug prescribed for active symptoms is budesonide. Budesonide is a synthetic steroid like prednisone that decreases inflammation. […] Budesonide has been shown to improve symptoms in 8 out of 10 people with a limited side effect profile. Budesonide is poorly absorbed into the bloodstream and has the advantage over prednisone by only affecting the inner lining of the intestinal tract.

• #2 Long-Term Budesonide for Microscopic Colitis Is Effective Maintenance Treatment

  https://www.gastroenterologyadvisor.com/news/long-term-budesonide-for-microscopic-colitis-is-effective-maintenance-treatment/

  Budesonide treatment has a lower risk for adverse effects due to its high first-pass metabolism, favoring its use over other systemic corticosteroids for MC maintenance therapy. […] Similar to induction, MC patients treated with budesonide maintenance therapy have high rates of pooled clinical remission, including both CC [collagenous colitis] and LC [lymphocytic colitis] subtypes.

• #2 A Functional Medicine Approach to Treating Microscopic Colitis

  https://www.rupahealth.com/post/a-functional-medicine-approach-to-treating-microscopic-colitis

  Other pharmacologic agents that may be considered for patients in whom budesonide is not an option include mesalamine, bismuth subsalicylate, prednisone, and cholestyramine. […] Prolonged use of budesonide may increase the risk of bone loss over time, leading many to explore alternative options with a lower side effect profile. […] Natural supplements with properties that may support inflammation management include Boswellia serrata, curcumin, psyllium (Plantago ovata), and ginger. […] Lifestyle modifications should be emphasized as an essential first step, including the avoidance of all NSAIDs and, if possible, the discontinuation of other medications associated with increased condition risk. […] Dietary and lifestyle modifications, botanical options, and nutritional supplements may help patients achieve long-term symptom management without reliance upon pharmacologic maintenance therapy.

• #2 Microscopic Colitis: Types, Symptoms, and Treatment

  https://www.webmd.com/ibd-crohns-disease/microscopic-colitis

  Sometimes, microscopic colitis goes away on its own. If not, your doctor may suggest you take these steps: […] If those don’t work, your doctor may suggest medications: […] If these treatments don’t work, you may need medications to suppress the immune system, such as azathioprine (Imuran). Surgery for microscopic colitis is an option, but very few people ever need it. […] For most people with microscopic colitis, treatment generally works well. Some people have relapses after they stop treatment.

• #2 Microscopic Colitis | All you need to know | Gastro Health

  https://gastrohealth.com/news/patient-care/microscopic-colitis

  There is no evidence that microscopic colitis leads to an increase risk of colon cancer, as with ulcerative colitis. […] Management of microscopic colitis includes lifestyle changes aimed at reducing the diarrhea and discontinuing drugs like Nsaids and PPis. Dietary recommendations include reducing the amount of caffeine, lactose and fat in the diet. In many cases, treatment with antidiarrheal medications is necessary. Loperamide, Bismuth (Pepto Bismol), bulking agents like psyllium, or bile acid binding resins like cholestyramine are commonly used in the treatment of microscopic colitis. In more severe cases of diarrhea, corticosteroids can be used as treatment. Corticosteroids are medications that decrease inflammation and reduce the activity of the immune system. However, these medications can have many side effects. Budesonide, is a type of corticosteroid that is considered to be safer with fewer side effects, than others such as prednisone. Therefore, this is the treatment of choice. […] In order to diagnose microscopic colitis, a physician must obtain a biopsy from the colon. In most cases, it can be easily treated and symptoms managed so patients can function normally.

• #2 SciELO Brazil – DIAGNOSIS AND TREATMENT OF MICROSCOPIC COLITIS: POSITION PAPER ON BEHALF OF THE BRAZILIAN FEDERATION OF GASTROENTEROLOGY DIAGNOSIS AND TREATMENT OF MICROSCOPIC COLITIS: POSITION PAPER ON BEHALF OF THE BRAZILIAN FEDERATION OF GASTROENTEROL

  https://www.scielo.br/j/ag/a/tPZKRdCPbYCzSSxdgHZfwKL/

  Budesonide remains the first-line treatment for inducing remission in MC due to its proven efficacy and favorable safety profile. However, in Brazil, where access to standard therapies for MC can be challenging, at least currently due to difficulties in obtaining budesonide, it is imperative to have alternative treatment options available. […] Patients with MC who are unresponsive or intolerant to budesonide and or second line therapies may benefit from immunosuppressive therapy with agents such as azathioprine, anti-TNF agents and anti-integrin agents. Data on the use of anti-interleukin agents and JAK inhibitors in MC are scarce.

• #2 Microscopic Colitis: Treatment, Symptoms & What It Is

  https://my.clevelandclinic.org/health/diseases/17227-microscopic-colitis

  If you don’t respond to the above medications, and if your doctor believes there is an autoimmune factor involved, they might suggest additional medications to target your immune response, such as: Immunosuppressants. TNF inhibitors (adalimumab, infliximab). Cromolyn sodium to target mast cells (mastocytic enterocolitis). Low dose naltrexone. […] Your doctor may suggest: Eliminating common triggers. […] To manage flare-ups, some healthcare providers recommend a gastrointestinal soft diet, which is made up of low fat and low fiber foods. […] The Mediterranean diet is a good example of a diet that promotes anti-inflammatory foods. […] Microscopic colitis is still not well understood. […] Fortunately, the treatments we have often work to manage it.

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