What Is the First-Line Treatment for Microscopic Colitis?
Microscopic colitis presents with chronic, watery diarrhoea and a macroscopically normal or near-normal colon on endoscopy. This first-line protocol targets induction of clinical remission through a structured approach combining pharmacological therapy with elimination of recognised risk factors.
Treatment Approach
Induction relies on a locally acting oral corticosteroid, alongside systematic identification and withdrawal of medications or exposures with a suspected causal role. For patients with intolerance to the primary agent or with mild disease, alternative symptom-control options are available. The full regimen — including sequencing, selection criteria, and duration — is detailed in the structured protocol.
Remission Target
Clinical remission is defined by the Hjortswang criteria: a mean of fewer than 3 stools per day and fewer than 1 watery stool per day over a one-week registration period. This is assessed after the induction course.
References
DOI: 10.1177/2050640620951905
- We recommend using oral budesonide to induce remission in patients with CC.
- We recommend using oral budesonide to induce remission in patients with LC.
- After six to eight weeks of treatment, pooled analysis revealed 81% (62/77) of patients treated with budesonide 9 mg/d achieved a clinical response compared to 36% (30/84) of patients treated with placebo (relative risk (RR) 2.98, 95% CI: 1.14–7.75; random-effects).
- We suggest to consider withdrawal of any drugs with a suspected chronological relationship between drug introduction and onset of diarrhoea.
- Given the documented effect in patients with chronic diarrhoea, the expert's opinion favours the use of this drug in mild disease.
- Statement 3.4: In the absence of a formally validated metric of disease activity, disease activity and clinical remission in MC should be assessed by the Hjortswang criteria (clinical remission: mean of <3 stools per day and a mean <1 water stool per day during a one-week registration).
- Therefore, it was proposed that remission in CC should be defined as a mean of <3 stools per day and a mean <1 watery stool per day during a one-week registration.
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