Treatments for collagenous colitis

  • Home / Treatments for collagenous colitis

Treatments for collagenous colitis

Updated
Authors: 
Kafil TS, Nguyen TM, Patton PH, MacDonald JK, Chande N, McDonald J

What is collagenous colitis?

Collagenous colitis is a type of microscopic colitis, a condition characterized by chronic watery non-bloody diarrhea. People with collagenous colitis have a normal appearing bowel when assessed by an endoscope (a camera used to look at the bowel); but have microscopic inflammation of the bowel when assessed by a biopsy (a tissue sample taken during endoscopy). The cause of this disorder is unknown.

What treatments have been tried for lymphocytic colitis?

Budesonide, mesalamine, cholestyramine, Boswellia serrata extract, probiotics, prednisolone and Pepto-Bismol® have been studied as treatment for collagenous colitis. Budesonide is an immunosuppressive steroid drug that is quickly metabolized by the liver resulting in reduced steroid-related side-effects. Prednisolone is a steroid drug used to treat inflammation. Mesalamine (also known as 5-ASA) is an anti-inflammatory drug. Cholestyramine is a drug that helps the body remove bile acids. Pepto-Bismol®, is an antacid medication used to treat discomforts of the stomach and gastrointestinal tract. Boswellia serrata extract is a herbal extract. Probiotics are found in yogurt or dietary supplements and contain potentially beneficial bacteria or yeast.

What did the researchers investigate?

The researchers investigated whether these treatments improve symptoms (e.g. diarrhea) or microscopic inflammation of collagenous colitis and whether any side effects (harms) result from treatment. The researchers searched the medical literature extensively up to 7 November 2016.

What did the researchers find?

Twelve studies (476 participants) were identified. Four studies were high quality. One study assessing mesalamine and cholestyramine was judged to be low quality and the other studies were judged to be of unclear quality due to poor reporting of methods.

Diarrhea resolved in 100% (4/4) of Pepto-Bismol® (nine 262 mg tablets daily for 8 weeks) participants compared to 0% (0/5) of placebo participants (1 study; very low quality evidence). Diarrhea resolved in 44% (7/16) of Boswellia serrata participants (three 400 mg/day capsules for 8 weeks) compared to 27% (4/15) of placebo participants (1 study; low-quality evidence). Diarrhea resolved in 80% (24/30) of budesonide participants compared to 44% (11/25) of mesalamine participants (1 study; low-quality evidence). There was no difference between the two treatments with respect to side effects. Diarrhea resolved in 44% (11/25) of mesalamine (3 g/day) participants compared to 59% (22/37) of placebo participants (1 study; low-quality evidence). There was no difference between the two treatments with respect to side effects. Diarrhea resolved in 63% (5/8) of prednisolone (50 mg/day for 2 weeks) participants compared to 0% (0/3) of placebo participants (1 study, low-quality evidence). Diarrhea resolved in 29% (6/21) of participants who received probiotics (2 capsules containing probiotics twice daily for 12 weeks) compared to 13% (1/8) of placebo participants (1 study, very low-quality evidence). Diarrhea resolved in 73% (8/11) of mesalamine (800 mg three times daily) participants compared to 100% (12/12) of mesalamine + cholestyramine participants (4 g daily) (1 study, very low-quality evidence). Diarrhea resolved in 81% (38/47) of budesonide (9 mg daily for 6-8 weeks) participants compared to 17% (8/47) of placebo participants (3 studies; low-quality evidence). Improvement in microscopic inflammation occurred in 72% (34/47) of budesonide participants compared to 17% (8/47) placebo participants (low-quality evidence). Resolution of diarrhea was maintained over 6 months in 68% (57/84) of budesonide participants compared to 20% (18/88) of placebo participants (3 studies, low-quality evidence). Improvement in microscopic inflammation was maintained in 48% (19/40) of budesonide participants compared to 15% (6/40) of placebo participants (2 studies; very low-quality evidence). No difference was found between budesonide and placebo for side effects (low-quality evidence) or serious side effects (very low-quality evidence). Side effects reported in the budesonide studies include nausea, vomiting, neck pain, abdominal pain, excessive sweating and headache. Side effects reported in the mesalamine studies included nausea and skin rash. Side effects in the prednisolone study included abdominal pain, headache, sleep disturbance, mood change and weight gain.

In conclusion, low quality evidence suggests that budesonide may be an effective therapy for active and inactive collagenous colitis. Due to small sample sizes and low study quality we are uncertain about the benefits and harms of therapy with Pepto-Bismol®, Boswellia serrata extract, mesalamine with or without cholestramine, prednisolone and probiotics. These agents and other therapies require further study.

About Post Author

Medical CPD & News

The Digitalis CPD trawler searches the web for all the latest news and journals.

Privacy Preference Center

Close your account?

Your account will be closed and all data will be permanently deleted and cannot be recovered. Are you sure?

Are you sure?

By disagreeing you will no longer have access to our site and will be logged out.