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Optimal management of collagenous colitis: a review

Authors O'Toole A

Received 4 June 2015

Accepted for publication 26 October 2015

Published 10 February 2016 Volume 2016:9 Pages 31—39


Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Prof. Dr. Jan Bilski

Peer reviewer comments 5

Editor who approved publication: Professor Andreas M Kaiser

Aoibhlinn O’Toole

Department of Gastroenterology, Beaumont Hospital, Dublin, Ireland

Abstract: Collagenous colitis (CC) is an increasingly recognized cause of chronic inflammatory bowel disease characterized by watery non-bloody diarrhea. As a lesser studied inflammatory bowel disease, many aspects of the CC's natural history are poorly understood. This review discusses strategies to optimally manage CC. The goal of therapy is to induce clinical remission, <3 stools a day or <1 watery stool a day with subsequent improved quality of life (QOL). Antidiarrheal can be used as monotherapy or with other medications to control diarrhea. Budesonide therapy has revolutionized treatment and is superior to prednisone, however, the treatment is associated with high-relapse rates and the management of refractory disease is challenging. Ongoing trials will address the safety and efficacy of low-dose maintenance therapy. For those with refractory disease, case reports and case series support the role of biologic agents. Diversion of the fecal stream normalizes colonic mucosal changes and ileostomy may be considered where anti-tumor necrosis factor (TNF)-α agents are contraindicated. Underlying celiac disease, bile salt diarrhea, and associated thyroid dysfunction should be ruled out. The author recommends smoking cessation as well as avoidance of nonsteroidal anti-inflammatories as well as other associated medications.

Keywords: microscopic, collagenous, lymphocytic, colitis, diarrhea, budesonide, inflammatory bowel disease

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