American Gastroenterological Association Institute Guideline on the Medical Management of Microscopic Colitis

Abstract

Artículo de publicación ISIThis article has an accompanying continuing medical education activity on page e17. Learning Objective: Upon completion of this test, successful learners will be able to: (1) learn first-line treatment for the induction of remission in microscopic colitis; (2) identify the expected clinical benefits and adverse effects of induction therapy for microscopic colitis; (3) understand the indications for and dosing of maintenance therapy for microscopic colitis; (4) consider medications that may precipitate microscopic colitis especially in those who are refractory to medical therapy; and (5) become familiar with treatment strategies for microscopic colitis refractory to first-line therapy

Macroscopic Findings in Microscopic Colitis: Two Case Reports and a Review of Literature

“…The overall response may be expected for up to 81% of MC patients. Regarding maintenance of histological response, meta-analysis showed that budesonide 6 mg reduces the risk of histological relapse by 79% (RR, 0.21; 95% CI, 0.08-0.54) [24]. Other medications that have shown some benefit include bismuth salicylate or mesalazine plus cholestyramine, but they have lesser possibility of successful remission, compared to budesonide [25].…”

Diagnostic Algorithm and Treatment for Microscopic Colitis: A Review.

“…Many cases are self-limiting, with symptoms lasting a few weeks or months and resolution of diarrhea in up to 50% of patients receiving steroid treatment (Ingle 2014) (Villanacci et al 2016). Unlike other inflammatory bowel diseases (IBD), there is no evidence that the persistence of histological inflammation predicts long-term negative outcomes such as colorectal cancer or need for surgery (Nguyen et al 2016)(Pardi, Tremaine, and Carrasco-Labra 2016).…”

“…Risk factors associated with relapse included high-stool frequency at baseline and a long duration of diarrhea (O'Toole 2016). AGA recommends, for patients with recurrence of symptoms following discontinuation of induction therapy for MC, budesonide for maintenance of clinical remission (Nguyen et al 2016). A lower dose of budesonide (3 mg daily alternating with 6 mg daily) over 12 months showed similar efficacy in maintaining clinical response (Nguyen et al 2016).…”

“…AGA recommends, for patients with recurrence of symptoms following discontinuation of induction therapy for MC, budesonide for maintenance of clinical remission (Nguyen et al 2016). A lower dose of budesonide (3 mg daily alternating with 6 mg daily) over 12 months showed similar efficacy in maintaining clinical response (Nguyen et al 2016). Although the systemic bioavailability of budesonide is low, prolonged use may predispose to bone loss (Nguyen et al 2016).…”

“…Although the systemic bioavailability of budesonide is low, prolonged use may predispose to bone loss (Nguyen et al 2016). Maintained long term on budesonide should be assessed for steroidrelated side effects, such as hypertension, hyperglycemia, metabolic bone disease (osteoporosis) and prevention and screening should be considered (Nguyen et al 2016) (Pardi 2017).…”