Gastroenterol Res

Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access

Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc

Journal website http://www.gastrores.org

Original Article

Volume 10, Number 6, December 2017, pages 329-333

Medical Treatment for Microscopic Colitis: A Community Hospital’s Experience

**Table 1.** Demographics of Patients With Biopsy Confirmed Lymphocytic, Collagenous or Microscopic Colitis
	ALL	Treated	Post-therapy 1
CC: collagenous colitis; LC: lymphocytic colitis; MC: microscopic colitis; RA: rheumatoid arthritis; SLE: systemic lupus erythematosus; BMs/D: bowel movements per day.
Number	114	51% (58/114)	-
Type			-
CC	77% (88/114)	81% (47/58)	-
LC	16% (18/114)	15% (9/58)	-
MC	7% (8/114)	3% (2/58)	-
Race/Caucasian	97% (113/114)	-	-
Gender/female	88% (111/114)	86% (50/58)	-
Average age	69 ± 13	69 ± 11	-
Associated autoimmune diseases (RA n = 3, SLE n = 2, psoriasis n = 1, Hashimoto’s thyroiditis n = 1, temporal arteritis n = 1)	7% (8/114)	-	-
Average BMs/D	5.0 ± 3.3	5.1 ± 3.4	2.9 ± 2.4

Table 1. Demographics of Patients With Biopsy Confirmed Lymphocytic, Collagenous or Microscopic Colitis

ALL

Treated

Post-therapy 1

CC: collagenous colitis; LC: lymphocytic colitis; MC: microscopic colitis; RA: rheumatoid arthritis; SLE: systemic lupus erythematosus; BMs/D: bowel movements per day.

Number

114

51% (58/114)

Type

77% (88/114)

81% (47/58)

16% (18/114)

15% (9/58)

7% (8/114)

3% (2/58)

Race/Caucasian

97% (113/114)

Gender/female

88% (111/114)

86% (50/58)

Average age

69 ± 13

69 ± 11

Associated autoimmune diseases (RA n = 3, SLE n = 2, psoriasis n = 1, Hashimoto’s thyroiditis n = 1, temporal arteritis n = 1)

7% (8/114)

Average BMs/D

5.0 ± 3.3

5.1 ± 3.4

2.9 ± 2.4

**Table 2.** Patients Starting on Therapy
Patients on therapy	58
Unknown start date	4
Therapy started prior to colonoscopy	13
Therapy started on day of colonoscopy	8
Therapy started after colonoscopy	33

Table 2. Patients Starting on Therapy

Patients on therapy

Unknown start date

Therapy started prior to colonoscopy

Therapy started on day of colonoscopy

Therapy started after colonoscopy

**Table 3.** Patients on Therapy, Type, Change and Reason for Change
Number of patients	Therapy 1	Daily dose (mg)	Number of patients	Δ→ Therapy 2	Daily dose (mg)	Number of patients	Δ→ Therapy 3	Daily dose (mg)
BID: twice daily; TID: three times daily; QID: four times daily; ND: not documented; PRN: as needed.
58			20			8
29	Budesonide		7	24% (7/29)		3
18	Budesonide	9	1	Insurance/change brand	9	1	Non-compliance/budesonide	9
	Budesonide	9	1	Wean off/5-ASA			-	-
	Budesonide	9	1	Maintenance/5-ASA	2,400	1	Failure/budesonide	6
	Budesonide	9	1	9 → 3 taper failure/5-ASA	2,400	1	Failure/prednisone	?
8	Budesonide	6	1	9 → 3 taper failure/ 5-ASA	4,500		-	-
	Budesonide	6	1	Mild symptoms/diphenoxylate/atropine	2.5/0.025 TID		-	-
3	Budesonide	3	1	ND/loperamide	4		-	-
13	5-ASA		5	38% (5/13)		3
4	5-ASA	1,200	1	Failure/prednisone	40	1	Side effects/budesonide	6
3	5-ASA	1,600	1	Failure/budesonide	9 → 6	1	Remissio/5-ASA	2,400
4	5-ASA	2,400	1	Flare/prednisone	10	1	Osteoporosis/5-ASA	2,400
1	5-ASA	4,800	1	Failure/budesonide	9		-	-
1	5-ASA	4,800	1	Bloating/5-ASA	-		-	-
5	Diphenoxylate/atropine	2.5/0.025	4	80% (4/5)
1	Diphenoxylate/atropine	BID	1	Failure/budesonide	9		-	-
1	Diphenoxylate/atropine	TID	1	Failure/5-ASA	1,200		-	-
1	Diphenoxylate/atropine	QID	1	Failure/hyocyamine	0.375	1	Failure/budesonide	9
2	Diphenoxylate/atropine	ND	1	5-ASA	ND		-	-
3	Bismuth subsalicylate	262	1	33% (1/3)
1	Bismuth subsalicylate	BID	1	Budesonide	6		-	-
1	Bismuth subsalicylate	TID	-	-	-		-	-
1	Bismuth subsalicylate	QID	-	-	-		-	-
3	Antibiotics		2	66% (2/3)
1	Metronidazole	500 TID	1	Liprofloxacin	500 BID		-	-
2	Metronidazole + ciprofloxacin	500 TID/500 BID	1	Loperamide	4 PRN		-	-
2	Hyocyamine
2	Hyocyamine	0.125 QID	-	-	-		-	-
1	Cholestyramine	ND	-	-	-		-	-
1	Prednisone	10/taper	-	-	-		-	-
1	Fiber	600	1	100% (1/1)dicyclomine	20	1	Failure/loperamide	2

Table 3. Patients on Therapy, Type, Change and Reason for Change

Number of patients

Therapy 1

Daily dose (mg)

Number of patients

Δ→ Therapy 2

Daily dose (mg)

Number of patients

Δ→ Therapy 3

Daily dose (mg)

BID: twice daily; TID: three times daily; QID: four times daily; ND: not documented; PRN: as needed.

Budesonide

24% (7/29)

Budesonide

Insurance/change brand

Non-compliance/budesonide

Budesonide

Wean off/5-ASA

Budesonide

Maintenance/5-ASA

2,400

Failure/budesonide

Budesonide

9 → 3 taper failure/5-ASA

2,400

Failure/prednisone

Budesonide

9 → 3 taper failure/ 5-ASA

4,500

Budesonide

Mild symptoms/diphenoxylate/atropine

2.5/0.025 TID

Budesonide

ND/loperamide

5-ASA

38% (5/13)

5-ASA

1,200

Failure/prednisone

Side effects/budesonide

5-ASA

1,600

Failure/budesonide

9 → 6

Remissio/5-ASA

2,400

5-ASA

2,400

Flare/prednisone

Osteoporosis/5-ASA

2,400

5-ASA

4,800

Failure/budesonide

5-ASA

4,800

Bloating/5-ASA

Diphenoxylate/atropine

2.5/0.025

80% (4/5)

Diphenoxylate/atropine

BID

Failure/budesonide

Diphenoxylate/atropine

TID

Failure/5-ASA

1,200

Diphenoxylate/atropine

QID

Failure/hyocyamine

0.375

Failure/budesonide

Diphenoxylate/atropine

5-ASA

Bismuth subsalicylate

262

33% (1/3)

Bismuth subsalicylate

BID

Budesonide

Bismuth subsalicylate

TID

Bismuth subsalicylate

QID

Antibiotics

66% (2/3)

Metronidazole

500 TID

Liprofloxacin

500 BID

Metronidazole + ciprofloxacin

500 TID/500 BID

Loperamide

4 PRN

Hyocyamine

0.125 QID

Cholestyramine

Prednisone

10/taper

Fiber

600

100% (1/1)dicyclomine

Failure/loperamide

**Table 4.** Average Reduction of Bowel Movements per Day for Budesonide and 5-ASA
Therapy	Budesonide	5-ASA (Mesalamine)
BMs/D: bowel movements per day.
BMs/D reduced →	4.7 → 2.4	5.8 → 2.8

Table 4. Average Reduction of Bowel Movements per Day for Budesonide and 5-ASA

Therapy

Budesonide

5-ASA (Mesalamine)

BMs/D: bowel movements per day.

BMs/D reduced →

4.7 → 2.4

5.8 → 2.8

**Table 5.** Symptoms Exacerbation Ratios, Therapies Used Before and After Exacerbations
Symptom exacerbation	11/58 (19%)	Improved/resolved
While on 5-ASA	(3/11)	Change to budesonide 9 mg/day
	(1/11)	Change to prednisone 10 mg/day
While on budesonide 9 mg/day	(3/11)	Change to 5-ASA
Lowering budesonide 9 mg to 3 mg	(2/11)	Increase budesonide to 9 mg
While on budesonide 3 mg/day	(1/11)	Increase budesonide to 9 mg
Discontinuation of budesonide 9 mg/day (given for 1 month)	(1/11)	Restarted budesonide 6 mg/day × 1 month, then 3 mg/day

Table 5. Symptoms Exacerbation Ratios, Therapies Used Before and After Exacerbations

Symptom exacerbation

11/58 (19%)

Improved/resolved

While on 5-ASA

(3/11)

Change to budesonide 9 mg/day

(1/11)

Change to prednisone 10 mg/day

While on budesonide 9 mg/day

(3/11)

Change to 5-ASA

Lowering budesonide 9 mg to 3 mg

(2/11)

Increase budesonide to 9 mg

While on budesonide 3 mg/day

(1/11)

Increase budesonide to 9 mg

Discontinuation of budesonide 9 mg/day (given for 1 month)

(1/11)

Restarted budesonide 6 mg/day × 1 month, then 3 mg/day