Interventions for treating collagenous colitis

Kafil, Tahir S; Nguyen, Tran M; Patton, Petrease H; MacDonald, John K; Chande, Nilesh; McDonald, John W.D.

doi:10.1002/14651858.cd003575.pub6

Cited by 57 publications

(43 citation statements)

References 40 publications

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“…192,195 In all seven RCTs, HRQoL was markedly altered at baseline in both CC and LC patients, and improved after budesonide treatment. [196][197][198] Are there established metrics to measure disease activity and clinical remission in MC?…”

Section: Very Lowmentioning

confidence: 99%

European guidelines on microscopic colitis: United European Gastroenterology and European Microscopic Colitis Group statements and recommendations

et al. 2021

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Introduction Microscopic colitis is a chronic inflammatory bowel disease characterised by normal or almost normal endoscopic appearance of the colon, chronic watery, non-bloody diarrhoea and distinct histological abnormalities, which identify three histological subtypes, the collagenous colitis, the lymphocytic colitis and the incomplete microscopic colitis. With ongoing uncertainties and new developments in the clinical management of microscopic colitis, there is a need for evidence-based guidelines to improve the medical care of patients suffering from this disorder. Methods Guidelines were developed by members from the European Microscopic Colitis Group and United European Gastroenterology in accordance with the Appraisal of Guidelines for Research and Evaluation II instrument. Following a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation methodology was used to assess the certainty of the evidence. Statements and recommendations were developed by working groups consisting of gastroenterologists, pathologists and basic scientists, and voted upon using the Delphi method. Results These guidelines provide information on epidemiology and risk factors of microscopic colitis, as well as evidence-based statements and recommendations on diagnostic criteria and treatment options, including oral budesonide, bile acid binders, immunomodulators and biologics. Recommendations on the clinical management of microscopic colitis are provided based on evidence, expert opinion and best clinical practice. Conclusion These guidelines may support clinicians worldwide to improve the clinical management of patients with microscopic colitis.

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Section: Very Lowmentioning

confidence: 99%

European guidelines on microscopic colitis: United European Gastroenterology and European Microscopic Colitis Group statements and recommendations

et al. 2021

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“…The controlled‐release formulations of oral budesonide are proven both effective and well tolerated in patients with ileoceacal Crohn´s disease and have been a breakthrough in the treatment of microscopic colitis (MC) . Unlike most other oral corticosteroids, budesonide has a substantial first‐pass metabolism.…”

Section: Introductionmentioning

confidence: 99%

“…Thereby, it exerts an immunosuppressant effect in the gut wall and is subsequently metabolised in the liver, thus resulting in quite a low systemic bioavailability, about 10% compared to more than 80% for prednisolone . This ingenious leveraging of first‐pass metabolism has enabled us to use budesonide for maintenance treatment of MC without undue toxicity …”

Section: Introductionmentioning

confidence: 99%

“…The controlled-release formulations of oral budesonide are proven both effective and well tolerated in patients with ileoceacal Crohn´s disease 1,2 and have been a breakthrough in the treatment of microscopic colitis (MC). 3,4 Unlike most other oral corticosteroids, budesonide has a substantial first-pass metabolism. Thereby, it exerts an immunosuppressant effect in the gut wall and is subsequently metabolised in the liver, thus resulting in quite a low systemic bioavailability, about 10% 1 compared to more than 80% for prednisolone.…”

Section: Introductionmentioning

confidence: 99%

“…5 This ingenious leveraging of first-pass metabolism has enabled us to use budesonide for maintenance treatment of MC without undue toxicity. 3,4 However, adverse effects related to long-term use of corticosteroids are of concern. Oral corticosteroids in general are known to increase the risk of osteoporotic fractures through a reduction in bone formations and osteocyte apoptosis.…”

Section: Introductionmentioning

confidence: 99%

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Long‐term oral budesonide treatment and risk of osteoporotic fractures in patients with microscopic colitis

Reilev

Hallas

Ernst

et al. 2020

Aliment Pharmacol Ther

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Summary Background Due to a substantial first‐pass metabolism of oral budesonide, systemic bioavailability is low compared to other oral corticosteroids, thereby possibly avoiding adverse effects of systemic corticosteroid use. Aim To determine whether use of oral budesonide is associated with osteoporotic fractures in patients with microscopic colitis (MC). Methods Applying data from the Danish nationwide health registries, we conducted a case‐control study nested within a cohort of patients with MC from 2004 to 2012. We estimated odds ratios (ORs) for the association between budesonide use and osteoporotic fractures (hip, wrist and spinal fractures). Results We identified 417 cases with a first occurrence of an osteoporotic fracture. Eighty‐six per cent were women and the median age was 78 years. The OR for the overall association between ever‐use of budesonide and any osteoporotic fractures did not reach statistical significance (OR 1.13, CI: 0.88‐1.47). The highest risk was observed for spinal fractures (OR 1.98, CI: 0.94‐4.17), where a dose‐response association seemed to exist, followed by hip and wrist fractures (OR 1.17 [CI: 0.79‐1.73] and OR 0.99 [CI: 0.66‐1.47] respectively). We generally found modestly increased ORs across subgroups at suspected high or low risk of fractures (1.00‐2.49). No overall dose‐response association was evident (OR for doubling of cumulative dose 0.93 (CI: 0.84‐1.03). Conclusion No overall association between use of oral budesonide and osteoporotic fractures was demonstrated among individuals with MC. There seemed to be an isolated adverse effect of budesonide on the risk of spinal fractures, which appears to be dose related.

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Interventions for treating collagenous colitis

Kafil

Nguyen

Patton

et al. 2017

Cochrane Database of Systematic Reviews

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BackgroundCollagenous colitis is a cause of chronic diarrhea. This updated review was performed to identify therapies for collagenous colitis that have been assessed in randomized controlled trials (RCTs). ObjectivesThe primary objective was to assess the benefits and harms of treatments for collagenous colitis. Search methodsWe searched CENTRAL, the Cochrane IBD Group Specialized Register, MEDLINE and EMBASE from inception to 7 November 2016. Selection criteriaWe included RCTs comparing a therapy with placebo or active comparator for the treatment of active or quiescent collagenous colitis. Data collection and analysisData were independently extracted by two authors. The primary outcome was clinical response or maintenance of response as defined by the included studies. Secondary outcome measures included histological response, quality of life and the occurrence of adverse events. Risk ratios (RR) and 95% confidence intervals (CI) were calculated for dichotomous outcomes. The Cochrane risk of bias tool was used to assess bias. The overall quality of the evidence was assessed using the GRADE criteria. Main resultsTwelve RCTs (476 participants) were included. These studies assessed bismuth subsalicylate, Boswellia serrata extract, mesalamine, cholestyramine, probiotics, prednisolone and budesonide therapy. Four studies were low risk of bias. One study assessing mesalamine and cholestyramine was judged to be high risk of bias due to no blinding. The other studies had an unclear risk of bias for random sequence generation (five studies) allocation concealment (six studies), blinding (one study), incomplete outcome data (one study) and selective outcome reporting (one study). Clinical response occurred in 100% (4/4) of patients who received bismuth subsalicylate (nine 262 mg tablets daily for 8 weeks) compared to 0% (0/5) of patients who received placebo (1 study; 9 participants; RR 10.80, 95% CI 0.75 to 155.93; GRADE = very low). Clinical response occurred in 44% (7/16) of patients who received Boswellia serrata extract (three 400 mg/day capsules for 8 weeks) compared to 27% (4/15) of patients who received placebo (1 study; 31 participants; RR 1.64, 1 Interventions for treating collagenous colitis (Review)

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Interventions for treating collagenous colitis

Cited by 57 publications

References 40 publications

European guidelines on microscopic colitis: United European Gastroenterology and European Microscopic Colitis Group statements and recommendations

European guidelines on microscopic colitis: United European Gastroenterology and European Microscopic Colitis Group statements and recommendations

Long‐term oral budesonide treatment and risk of osteoporotic fractures in patients with microscopic colitis

Interventions for treating collagenous colitis

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