Microscopic colitis is a common cause of chronic watery
diarrhea. Its etiology is unknown, but use of nonsteroidal antiinflammatory drugs,
aspirin, and
lansoprazole may be risk factors for developing the disorder.
Therapy is directed primarily at resolving the symptoms of
microscopic colitis;
bismuth subsalicylate, aminosalicylates, traditional
corticosteroids, and
budesonide have been evaluated. Compared with other
therapies,
budesonide has the strongest evidence for effectiveness in decreasing the volume and frequency of stools and improving the quality of life; it is, however, a costly
drug. We reviewed all available primary English-language literature accounts of treatment of
microscopic colitis. We performed searches of MEDLINE and International
Pharmaceutical Abstracts, as well as reviewing the bibliographies from key articles, to procure pertinent reports.
Microscopic colitis can be successfully treated with
pharmacotherapy. Based on cost and adverse-effect profiles,
antidiarrheals and
bismuth subsalicylate are reasonable first options, but many patients may require
budesonide to achieve remission.