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World J Gastroenterol. Jun 21, 2013; 19(23): 3531-3533
Published online Jun 21, 2013. doi: 10.3748/wjg.v19.i23.3531
Microscopic colitis: A therapeutic challenge
Mario Guslandi
Mario Guslandi, Gastroenterology Unit, S. Raffaele University Hospital, 20132 Milan, Italy
Author contributions: Guslandi M solely contributed to this paper.
Correspondence to: Mario Guslandi, MD, FACG, Professor, Gastroenterology Unit, S. Raffaele University Hospital, Via Olgettina 60, 20132 Milan, Italy. guslandi.mario@hsr.it
Telephone: +39-2-26432744 Fax: +39-2-26433491
Received: January 18, 2013
Revised: April 11, 2013
Accepted: April 28, 2013
Published online: June 21, 2013

The treatment of microscopic colitis is mainly based on the use of budesonide, the only drug found effective in controlled clinical trials. After an initial course at a dose of 9 mg daily, however, most patients relapse when the drug is discontinued, hence a maintenance therapy at doses of 6 mg daily or lower is necessary. In order to avoid steroid dependence and drug toxicity different pharmacological agents should be considered as an alternative to indefinite long-term budesonide treatment. Evidence-based guidelines are currently lacking due to the lack of conclusive data concerning the use of either immunosuppressive or anti-tumor necrosis factor agents. For the time being in clinical practice the skilled physician should therefore tailor long term management of microscopic colitis on the single patient.

Keywords: Microscopic colitis, Budesonide, Mesalazine, Immunosuppressants

Core tip: The efficacy of short-term treatment of microscopic colitis with budesonide is confirmed. Long-term therapy is not advisable because of possible side effects, but the efficacy of alternative drugs such as immunosuppressants or anti-tumor necrosis factor agents remains to be established. For the time being prolonged budesonide treatment in minimal doses, tailored on the single patient, appears to be the most sensible option.