Editorial
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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
Abstract

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.