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MICROSCOPIC COLITIS: EPIDEMIOLOGY, CLINICAL FEATURES AND RESPONSE TO TREATMENT IN 32 PATIENTS
L McKnight, N Chande
Division of Gastroenterology, University of Western Ontario, London, Ontario
Purpose: Many agents have been suggested as treatments for microscopic colitis. For most of these therapies, precise response rates remain unknown. Our goal was therefore to review the treatments initiated and response rates in 32 patients at a tertiary care outpatient clinic.
METHODS: We retrospectively reviewed the charts of 32 patients with biopsy-confirmed diagnoses of either collagenous or lymphocytic colitis. Information collected includes patient demographics, symptoms at presentation, associated conditions and treatment response. Treatment response was defined as complete response (CR) if bowel function returned to normal, partial response for a 50% reduction in frequency of bowel movements, failure for less than 50% reduction in frequency of bowel movements, and relapse for symptomatic decline during continued treatment. Median follow-up was 12.5 months.
RESULTS: The charts of 22 women and 10 men were reviewed, with a median age at diagnosis of 65 years old. Diarrhea was the most common symptom, occurring in 31 patients (97%). Fecal incontinence occurred in 11 patients (34%), and was the chief complaint in 2 cases (6%). Chronic intermittent symptoms occurred in 17 patients (53%), while 13 patients (41%) had a chronic continuous course. 2 patients (6%) experienced only a single episode of symptoms. The mean number of therapeutic agents initiated was 2.4 (range 0 to 12). No therapy was required in 3 cases (9%). Loperamide and bismuth subsalicylate, the two most commonly used agents, had CR rates of 35% and 36% respectively. Of all patients where loperamide, bismuth subsalicylate or a combination of these drugs were used, 52% of patients achieved CR. The highest CR rate was 60%, achieved with both prednisone and budesonide.
CONCLUSIONS: While budesonide and prednisone demonstrated the highest rates of symptomatic response in patients with microscopic colitis, other agents with less adverse events are also effective. We would recommend loperamide as a first line agent, with the addition of bismuth subsalicylate as required. This combination led to a complete response with normalization of bowel pattern in 52% of our patients.