2015-12-11 13:56:38 UTC

IBD 112: Treatment Options for Microscopic Colitis

Learn more about microscopic colitis in this patient companion, based on the AGA Clinical Guideline "The Medical Management of Microscopic Colitis."

Clinical practice guidelines are developed under the guidance of the AGA Institute Clinical Guideline Committee and provide evidence-based recommendations for clinical practice in the field of gastroenterology. The clinical practice guidelines and related Clinical Decision Support Tools support evidence-based clinical decision-making by gastroenterologists and other health-care professionals at the point of care. The below information presents important content from those guidelines in a way that will help patients better understand AGA’s recommendations for evaluating, diagnosing or managing a condition.

AGA Clinical Guideline: The Medical Management of Microscopic Colitis

The information provided by the AGA Institute is not medical advice and should not be considered a replacement for seeing a medical professional.


What is Microscopic Colitis?

Budesonide is the Best Drug to Try First

Consider Other Issues If Treatment Does Not Work

Questions For Your Doctor


What is Microscopic Colitis?

  • Microscopic colitis is a condition of the colon that causes watery diarrhea, pain, and nausea.
  • It is more common among people older than 60 years of age.
  • Microscopic colitis is caused by inflammation (irritation) of the colon, which is part of the large intestine.
  • Microscopic colitis can cause pain and discomfort and negatively affect quality of life.
    • Common symptoms include the following:
    • Watery diarrhea lasting at least four weeks.
    • Abdominal pain and cramping.
    • Unintentional weight loss.
    • Nausea.
  • To the naked eye, the colon of a person with microscopic colitis appears completely normal.
  • The disease gets its name from the fact that the swelling can only be seen under a microscope.
  • A gastroenterologist must perform a biopsy of the colon to find and diagnose microscopic colitis.
  • A biopsy of the colon is similar to a regular colonoscopy.
    • Like in a colonoscopy, your doctor inserts a flexible tube into the rectum to look inside the digestive tract.
    • Your doctor will then take a small bit of tissue from the colon to examine it for signs of inflammation. 
  • Microscopic colitis does not seem to increase the risk of cancer or other serious problems.

AnchorBudesonide Is the Best Drug for Patients to Try First

  • Budesonide (byoo-DESS-o-nide) is the most effective drug currently available for the treatment of microscopic colitis.
  • This drug is a corticosteroid that helps decrease inflammation in the gut. Less inflammation leads to a decrease in pain and other symptoms.
  • Taking a prescribed course of budesonide for eight weeks can double your chances of becoming symptom-free.
  • After eight weeks of successful treatment, your doctor may consider stopping the drug.
  • One of every three patients will live symptom-free after their first round of treatment.
  • Others may have another flare-up after stopping the drug. If this happens, you may need to take a smaller dose for up to a year to keep the symptoms from coming back.
  • Budesonide is effective with a low risk of side effects, but it is also expensive compared with other anti-inflammatory drugs. If you are concerned about being able to afford budesonide, ask your doctor about other lower-cost options.

Important note: Budesonide has a low risk of side effects because your liver quickly breaks it down. However, grapefruit, Echinacea, and some medications can affect the way your body breaks down the drug. You should avoid these while taking budesonide. Always make sure your doctor knows if you are on any other medications.

AnchorIf Symptoms Do Not Improve with Budesonide, Consider Other Issues

If your symptoms do not get better with budesonide, there may be another problem. In this case, your doctor should test you for other possible causes of your symptoms.

For instance, food allergies and intolerances can cause many of the same symptoms as microscopic colitis. If you suspect that you may be allergic or sensitive to a certain type of food, it is important to discuss this with your doctor before cutting anything out of your diet.

Celiac disease, an intolerance to gluten, is another condition that is associated with microscopic colitis. Patients who do not respond to budesonide should be tested for celiac disease.

Finding the cause of your symptoms will help your doctor prescribe a treatment plan that works for you.

AnchorQuestions For Your Doctor

  • What side effects are normal and expected for the drug you are prescribing?
  • What side effects are serious enough to contact a doctor?
  • How long will I have to take this medication? Will I need to be treated for the rest of my life?
  • Does this drug negatively interact with any other drugs I am taking?


January 2016

©AGA, July 2016

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