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Treatments and drugs
By Mayo Clinic staffMany cases of collagenous colitis and lymphocytic colitis get better on their own without treatment, usually within weeks. However, when the signs and symptoms are serious, doctors generally regard treatment as necessary.
The therapy is the same for both collagenous colitis and lymphocytic colitis. Doctors usually recommend a stepwise approach, starting with the simplest, most easily tolerated treatments. The goal is to produce the relief of symptoms.
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Lifestyle changes. As a first step, you'll need to make adjustments to your diet. By decreasing the amount of fat you consume, your signs and symptoms may ease. Also, remove caffeine from your diet (found in coffee, tea and soft drinks), as well as foods containing lactose (milk sugar found in dairy products). Avoid spicy foods and alcohol. Staying away from foods that may lead to gas and diarrhea — including carbonated beverages, caffeine, raw fruits, and vegetables such as beans, cauliflower, broccoli and cabbage — may help.
If you take over-the-counter nonsteroidal anti-inflammatory drugs — such as aspirin, ibuprofen and naproxen (Aleve) — talk to your doctor about switching to other types of pain relievers. These NSAIDs can worsen the diarrhea associated with collagenous colitis and lymphocytic colitis.
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Medications. If problems persist despite adjustments in lifestyle, the next step is to take medications. Before your doctor recommends medications, however, he or she will want to exclude other possible causes for your symptoms, such as celiac disease.
Doctors often advise starting with antidiarrheal preparations such as loperamide (Imodium) or the combination drug diphenoxylate and atropine (Lomotil) once the diagnosis is made. These drugs slow the contractions that propel the bowel contents through your colon. They're effective treatment for many people, particularly those whose diarrhea is mild to moderate, and they're well tolerated in most cases.
If signs and symptoms don't subside with these drugs, your doctor may suggest a different medication such as bismuth subsalicylate (Pepto-Bismol). The cholesterol-lowering drug cholestyramine (Questran) may be used. Cholestyramine helps treat lymphocytic colitis by absorbing bile acids that may be causing diarrhea. This medication is associated with the side effect of bloating.
If these medications don't relieve your symptoms, your doctor may recommend a course of treatment with a corticosteroid medication such as budesonide (Entocort). To reduce the risk of side effects, this medication is generally taken for a maximum of two months. For more severe cases, the corticosteroid called prednisone may be used, but this drug is associated with more side effects than budesonide. There is a chance your symptoms may recur after you finish a course of treatment with either of these corticosteroid medications.
Other medications that are used to reduce colon swelling and inflammation include anti-inflammatory medications such as mesalamine (Asacol, Pentasa) and sulfasalazine (Azulfidine) and immunosuppressive drugs such as methotrexate (Rheumatrex) and azathioprine (Imuran).
More studies are needed to fine-tune the role of all of these drugs in the management of collagenous colitis and lymphocytic colitis.
- Surgery. When the symptoms of collagenous colitis and lymphocytic colitis are severe, and medications aren't effective, your doctor may recommend surgery to remove inflamed portions of your colon, which tends to eliminate diarrhea. Surgery is rare for these conditions.
In many people with collagenous colitis or lymphocytic colitis, persistent symptoms can interfere with quality of life. But with proper treatment, the prognosis for most people is good, and symptoms gradually resolve completely.
- Collagenous Colitis and Lymphocytic Colitis. National Digestive Diseases Information Clearinghouse. http://digestive.niddk.nih.gov/ddiseases/pubs/collagenouscolitis/. Accessed Aug. 12, 2008.
- Collagenous Colitis and Lymphocytic Colitis. Merck Manual. http://www.merck.com/mmhe/sec09/ch126/ch126d.html. Accessed Aug. 12, 2008.
- Dietrich CF. Lymphocytic and collagenous colitis (microscopic colitis). http://www.uptodate.com/patients/content/topic.do?topicKey=inflambd/5666. Accessed Aug. 12, 2008.
- Wall, Geoffrey C. Pharmacotherapy for Microscopic Colitis. Pharmacotherapy. 2007;27(3):425-433.http://www.medscape.com/viewarticle/555432_1. Accessed Aug. 12, 2008.
- Colitis: A cause of persistent diarrhea in older adults. Mayo Clinic Health Letter.Vol. 25, No. 3, March 2007.
- Antidiarrheal Medicines: OTC Relief for Diarrhea. American Academy of Family Physicians. http://familydoctor.org/online/famdocen/home/otc-center/otc-medicines/855.html#ArticleParsysMiddleColumn0010. Accessed Aug. 12, 2008.
