Microscopic Colitis

Treatment

The steroid drug budesonide (bu-DES-uh-nide) is highly effective in eliminating the symptoms of microscopic colitis. For this reason, it is often the first choice of treatment. However, the drug is expensive, has some side effects and needs to be taken long term, because diarrhea reappears in most people who discontinue taking the drug.

Before turning to budesonide, another treatment approach is to carefully test people for other conditions that may be helped with less intensive treatment, including:

• Avoiding certain medications such as nonsteroidal, anti-inflammatory drugs such as ibuprofen (Advil, Motrin, others) or naproxen (Aleve) to see if the disease is drug-induced
• Trying gluten-free diets in people found to have celiac disease
• Trying bismuth subsalicylate (Pepto-Bismol or Kaopectate) to control symptoms in people with mild symptoms

In rare cases where the disease does not respond to any medication, a surgical procedure (ileostomy) may be recommended. In this procedure, the last part of the small intestine, the ileum, is attached to an opening in the abdominal wall. It may be performed with or without colectomy (removing all or part of the colon). In some people, the ileum can be attached to the anus after the colon is removed, avoiding a permanent ileostomy. Mayo gastroenterologic surgeons are experienced experts in these procedures.