Microscopic Colitis

Treatment

In many patients with microscopic colitis, diarrhea stops on its own after several years, or it goes into long-term remission. Other patients with microscopic colitis experience persistent or intermittent diarrhea for many years.

At Mayo Clinic, treatment of microscopic colitis follows a stepped approach, beginning with simple therapies and advancing to medications of gradually increasing strength only when necessary. These steps are summarized as follows:

1. The physician will recommend avoiding certain medications such as nonsteroidal, anti-inflammatory drugs (NSAIDS) such as ibuprofen or naproxen sodium. Sometimes conditions improve when patients avoid substances that may increase the chance of diarrhea, such as foods and beverages that contain caffeine and lactose.
2. If avoiding these substances does not help, the physician may recommend taking antidiarrhea medications such as Imodium or Lomotil.
3. If medications do not control the diarrhea, the physician may suggest taking a bismuth subsalicylate such as Pepto-Bismol or Kaopectate. It is one of the few medications that has been studied for managing microscopic colitis. It is often suggested instead of, or in conjunction with, antidiarrheal medications.
4. If bismuth is unsuccessful, the physician may prescribe the medication cholestyramine or an anti-inflammatory medication such as sulfasalazine, mesalamine or balsalazide.
5. If the previous therapies do not help, or if symptoms are particularly severe, the physician may prescribe corticosteroids such as prednisone or budesonide. These drugs have been considered a last resort, because of possible side effects. However, side effects are much less common with budesonide than with prednisone, and budesonide appears to be a very effective medication for microscopic colitis. (See Mayo study results on PubMed.) Patients may need to take another medication for maintenance therapy to avoid the side effects associated with long-term use of steroids.
6. 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). Mayo gastroenterologic surgeons are internationally recognized experts in these procedures.