MDCalc

Medical Management of Microscopic Colitis

Based on guidelines from the American Gastroenterological Association.

These guideline summaries are shared for educational purposes only and are not intended to direct patient care. For detail on the specific recommendations and information about the evidence considered by the guideline developer, we encourage you to go to the original guideline statement cited below.

Treatment

Treatment: Symptomatic Microscopic Colitis
Strong recommendation
Moderate quality evidence
The AGA recommends treatment with budesonide over no treatment for the induction of clinical remission.
Strong recommendation
High quality evidence
The AGA recommends treatment with budesonide over mesalamine for the induction of clinical remission.
Conditional recommendation
Low quality evidence
In patients in whom budesonide therapy is not feasible, the AGA suggests treatment with bismuth salicylate over no treatment for the induction of clinical remission.
Conditional recommendation
Very low quality evidence
In patients in whom budesonide therapy is not feasible, the AGA suggests treatment with prednisolone (or prednisone) over no treatment for the induction of clinical remission.
Conditional recommendation
Moderate quality evidence
In patients in whom budesonide therapy is not feasible, the AGA suggests treatment with mesalamine over no treatment for the induction of clinical remission.
Conditional recommendation
Low quality evidence
The AGA suggests against combination therapy with cholestyramine and mesalamine over mesalamine alone for the induction of clinical remission.
Conditional recommendation
Low quality evidence
The AGA suggests against treatment with Boswellia serrata over no treatment for the induction of clinical remission.
Conditional recommendation
Low quality evidence
The AGA suggests against treatment with probiotics over no treatment for the induction of clinical remission.
Treatment: Recurrent Symptoms
Strong recommendation
Moderate quality evidence
For patients with recurrence of symptoms following discontinuation of induction therapy for microscopic colitis, the AGA recommends budesonide for maintenance of clinical remission.
Literature
Original/Primary Reference
Research PaperNguyen GC, Smalley WE, Vege SS, et al. American gastroenterological association institute guideline on the medical management of microscopic colitis. Gastroenterology. 2016;150(1):242-246.