Year 2020 / Volume 112 / Number 1
Review
Treatment of microscopic colitis: the role of budesonide and new alternatives for refractory patients

53-58

DOI: 10.17235/reed.2019.6655/2019

Eukene Rojo, María José Casanova, Javier P. Gisbert,

Abstract
Microscopic colitis is a common cause of chronic watery diarrhea with a great impact on patient quality of life. Microscopic colitis includes two histological subtypes: collagenous colitis and lymphocytic colitis. Due to the increasing incidence and awareness of this disease over the last decades, several international guidelines have been recently published. However, there is still significant heterogeneity in the management of these patients, and treatments without solid scientific evidence support are often used in clinical practice. This article reviews the therapeutic role of budesonide in microscopic colitis and summarizes the current evidence regarding other treatments available for this disease, especially for the management of refractory patients. Finally, an updated treatment algorithm is proposed.
Share Button
New comment
Comments

01/08/2022 15:43:39
Lymphocytic colitis treatment alternatives to steroids


References
Fernandez-Banares F, Casanova MJ, Arguedas Y, et al. Current concepts on microscopic colitis: evidence-based statements and recommendations of the Spanish Microscopic Colitis Group. Aliment Pharmacol Ther 2016;43:400-26.
2. Hjortswang H, Tysk C, Bohr J, et al. Defining clinical criteria for clinical remission and disease activity in collagenous colitis. Inflamm Bowel Dis 2009;15:1875-81.
3. Cotter TG, Binder M, Loftus EV, Jr., et al. Development of a Microscopic Colitis Disease Activity Index: a prospective cohort study. Gut 2018;67:441-446.
4. Miehlke S, Acosta MB, Bouma G, et al. Oral budesonide in gastrointestinal and liver disease: A practical guide for the clinician. J Gastroenterol Hepatol 2018.
5. Johansson SA, Andersson KE, Brattsand R, et al. Topical and systemic glucocorticoid potencies of budesonide, beclomethasone dipropionate and prednisolone in man. Eur J Respir Dis Suppl 1982;122:74-82.
6. Edsbacker S, Andersson P, Lindberg C, et al. Liver metabolism of budesonide in rat, mouse, and man. Comparative aspects. Drug Metab Dispos. 1987 May-Jun;15(3):403-11.
7. Fedorak RN, Bistritz L. Targeted delivery, safety, and efficacy of oral enteric-coated formulations of budesonide. Adv Drug Deliv Rev 2005;57:303-16.
8. Edsbacker S, Larsson P, Bergstrand M. Pharmacokinetics of budesonide controlled-release capsules when taken with omeprazole. Aliment Pharmacol Ther 2003;17:403-8.
9. Baert F, Schmit A, D'Haens G, et al. Budesonide in collagenous colitis: a double-blind placebo-controlled trial with histologic follow-up. Gastroenterology 2002;122:20-5.
10. Bonderup OK, Hansen JB, Birket-Smith L, et al. Budesonide treatment of collagenous colitis: a randomised, double blind, placebo controlled trial with morphometric analysis. Gut 2003;52:248-51.
11. Miehlke S, Heymer P, Bethke B, et al. Budesonide treatment for collagenous colitis: a randomized, double-blind, placebo-controlled, multicenter trial. Gastroenterology 2002;123:978-84.
12. Miehlke S, Madisch A, Kupcinskas L, et al. Budesonide is more effective than mesalamine or placebo in short-term treatment of collagenous colitis. Gastroenterology 2014;146:1222-30.e1-2.
13. Kafil TS, Nguyen TM, Patton PH, et al. Interventions for treating collagenous colitis. Cochrane Database Syst Rev 2017;11:Cd003575.
14. Sebastian S, Wilhelm A, Jessica L, et al. Budesonide treatment for microscopic colitis: systematic review and meta-analysis. Eur J Gastroenterol Hepatol 2019;31:919-927.
15. Miehlke S, Madisch A, Karimi D, et al. Budesonide is effective in treating lymphocytic colitis: a randomized double-blind placebo-controlled study. Gastroenterology 2009;136:2092-100.
16. Pardi DS, Loftus EV, Tremaine WJ, et al. T1193 A Randomized, Double-Blind, Placebo-Controlled Trial of Budesonide for the Treatment of Active Lymphocytic Colitis. Gastroenterology 2009;136:A-519-A-520.
17. Chande N, Al Yatama N, Bhanji T, et al. Interventions for treating lymphocytic colitis. Cochrane Database Syst Rev 2017;7:Cd006096.
Miehlke S, Aust D, Mihaly E, Armerding P, Böhm G, Bonderup O, Fernández-Bañares F, Kupcinskas J, Munck LK, Rehbehn KU, Nacak T, Greinwald R, Münch A; BUG-1/LMC Study Group.Efficacy and Safety of Budesonide, vs Mesalazine or Placebo, as Induction Therapy for Lymphocytic Colitis. Gastroenterology. 2018 Dec;155(6):1795-1804.e3. doi: 10.1053/j.gastro.2018.08.042.
19. Bonderup OK, Hansen JB, Teglbjaerg PS, et al. Long-term budesonide treatment of collagenous colitis: a randomised, double-blind, placebo-controlled trial. Gut 2009;58:68-72.
20. Miehlke S, Madisch A, Voss C, et al. Long-term follow-up of collagenous colitis after induction of clinical remission with budesonide. Aliment Pharmacol Ther 2005;22:1115-9.
21. Miehlke S, Madisch A, Bethke B, et al. Oral budesonide for maintenance treatment of collagenous colitis: a randomized, double-blind, placebo-controlled trial. Gastroenterology 2008;135:1510-6.
22. Munch A, Bohr J, Miehlke S, et al. Low-dose budesonide for maintenance of clinical remission in collagenous colitis: a randomised, placebo-controlled, 12-month trial. Gut 2016;65:47-56.
23. Fernandez-Banares F, Piqueras M, Guagnozzi D, et al. Collagenous colitis: Requirement for high-dose budesonide as maintenance treatment. Dig Liver Dis 2017;49:973-977.
24. Greenberg GR, Feagan BG, Martin F, et al. Oral budesonide for active Crohn's disease. Canadian Inflammatory Bowel Disease Study Group. N Engl J Med 1994;331:836-41.
25. Vestergaard P, Rejnmark L, Mosekilde L. Fracture risk associated with different types of oral corticosteroids and effect of termination of corticosteroids on the risk of fractures. Calcif Tissue Int 2008;82:249-57.
26. Cino M, Greenberg GR. Bone mineral density in Crohn's disease: a longitudinal study of budesonide, prednisone, and nonsteroid therapy. Am J Gastroenterol 2002;97:915-21.
27. D'Haens G, Verstraete A, Cheyns K, et al. Bone turnover during short-term therapy with methylprednisolone or budesonide in Crohn's disease. Aliment Pharmacol Ther 1998;12:419-24.
28. Munch A, Aust D, Bohr J, et al. Microscopic colitis: Current status, present and future challenges: statements of the European Microscopic Colitis Group. J Crohns Colitis 2012;6:932-45.
29. Bohr J, Tysk C, Eriksson S, et al. Collagenous colitis: a retrospective study of clinical presentation and treatment in 163 patients. Gut 1996;39:846-51.
30. Olesen M, Eriksson S, Bohr J, et al. Lymphocytic colitis: a retrospective clinical study of 199 Swedish patients. Gut 2004;53:536-41.
31. Gentile NM, Abdalla AA, Khanna S, et al. Outcomes of patients with microscopic colitis treated with corticosteroids: a population-based study. Am J Gastroenterol 2013;108:256-9.
32. Munck LK, Kjeldsen J, Philipsen E, et al. Incomplete remission with short-term prednisolone treatment in collagenous colitis: a randomized study. Scand J Gastroenterol 2003;38:606-10.
33. Ung KA, Gillberg R, Kilander A, et al. Role of bile acids and bile acid binding agents in patients with collagenous colitis. Gut 2000;46:170-5.
34. Bajor A, Kilander A, Galman C, et al. Budesonide treatment is associated with increased bile acid absorption in collagenous colitis. Aliment Pharmacol Ther 2006;24:1643-9.
35. Pardi DS, Loftus EV, Jr., Tremaine WJ, et al. Treatment of refractory microscopic colitis with azathioprine and 6-mercaptopurine. Gastroenterology 2001;120:1483-4.
36. Munch A, Fernandez-Banares F, Munck LK. Azathioprine and mercaptopurine in the management of patients with chronic, active microscopic colitis. Aliment Pharmacol Ther 2013;37:795-8.
37. Cotter TG, Kamboj AK, Hicks SB, et al. Immune modulator therapy for microscopic colitis in a case series of 73 patients. Aliment Pharmacol Ther 2017;46:169-174.
38. Riddell J, Hillman L, Chiragakis L, et al. Collagenous colitis: oral low-dose methotrexate for patients with difficult symptoms: long-term outcomes. J Gastroenterol Hepatol 2007;22:1589-93.
39. Munch A, Bohr J, Vigren L, et al. Lack of effect of methotrexate in budesonide-refractory collagenous colitis. Clin Exp Gastroenterol 2013;6:149-52.
40. Esteve M, Mahadevan U, Sainz E, et al. Efficacy of anti-TNF therapies in refractory severe microscopic colitis. J Crohns Colitis 2011;5:612-8.
41. Munch A, Ignatova S, Strom M. Adalimumab in budesonide and methotrexate refractory collagenous colitis. Scand J Gastroenterol 2012;47:59-63.
42. Pola S, Fahmy M, Evans E, et al. Successful use of infliximab in the treatment of corticosteroid dependent collagenous colitis. Am J Gastroenterol 2013;108:857-8.
43. Anderson RJ, Makins R. Successful use of adalimumab in patient with treatment-refractory microscopic colitis. BMJ Case Rep 2016;2016.
44. Cushing KC, Mino-Kenudson M, Garber J, et al. Vedolizumab as a Novel Treatment for Refractory Collagenous Colitis: A Case Report. Am J Gastroenterol 2018;113:632-633.
45. Casper M, Zimmer V, Hubschen U, et al. Vedolizumab for refractory collagenous colitis: Another piece of the puzzle. Dig Liver Dis 2018;50:1099-1100.
46. Jennings JJ, Charabaty A. Vedolizumab-Induced Remission in 3 Patients With Refractory Microscopic Colitis: A Tertiary Care Center Case Series. Inflamm Bowel Dis 2019;25:e97.
47. Riviere P, Munch A, Michetti P, et al. Vedolizumab in Refractory Microscopic Colitis: An International Case Series. J Crohns Colitis 2019;13:337-340.
48. Jarnerot G, Tysk C, Bohr J, et al. Collagenous colitis and fecal stream diversion. Gastroenterology 1995;109:449-55.
49. Munch A, Soderholm JD, Wallon C, et al. Dynamics of mucosal permeability and inflammation in collagenous colitis before, during, and after loop ileostomy. Gut 2005;54:1126-8.
Related articles

Letter

Lymphocytic colitis with macroscopic findings

DOI: 10.17235/reed.2023.9497/2023

Review

Risk stratification and treatment of primary biliary cholangitis

DOI: 10.17235/reed.2018.5662/2018

Citation tools
Rojo E, Casanova M, Gisbert J. Treatment of microscopic colitis: the role of budesonide and new alternatives for refractory patients. 6655/2019


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 5932 visits.
This article has been downloaded 3465 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 02/10/2019

Accepted: 17/10/2019

Online First: 27/12/2019

Published: 10/01/2020

Article revision time: 9 days

Article Online First time: 86 days

Article editing time: 100 days


Share
This article has been rated by 9 readers.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2023 y Creative Commons. The Spanish Journal of Gastroenterology