getting back to normal To control diarrhea,
over-the-counter medication such as Lomotil (also
known as diphenoxylate and atropine sulfate) or
Imodium (loperamide) is often recommended. Though sometimes helpful, these agents usually just delay the
diarrhea. Occasionally, bulk-forming agents such as
It’s an embarrassing topic that we don’t like to discuss, but Metamucil and Citrucel or cholesterol-binding agents it happens to everyone from time to time: diarrhea.
(Questran, Welchol, Colestid) may be useful. Some
A major cause of chronic diarrhea that lasts more than
patients report that eight chewable Pepto-Bismol
three weeks is the inflammation of the colon or large
tablets per day are effective in taming collagenous
intestine, known as colitis. Two types of colitis—ulcerative colitis. However, these medications do not treat the colitis and Crohn’s disease—are the most common types of
underlying disease. Treating collagenous colitis requires
inflammatory bowel disease. However, a third type of colitis drugs that reduce inflammation.
called collagenous colitis is diagnosed with increasing fre-quency. No definite cause of collagenous colitis is known.
What is colitis, and how do i know if i have
it? Most individuals with collagenous colitis complain of
For mild to moderate symptoms
(less than six bowel
chronic, watery, nonbloody diarrhea, which may be con-
movements per day), the first line of medical treatment is
tinuous or episodic. Diarrhea may be mild (two to three
usually mesalamine (Asacol, Pentasa), an anti-inflammatory
daily bowel movements) or severe (more than 0 daily).
agent that reduces inflammation within the inner lining of
Severe cases can lead to weakness and dehydration.
the colon. This drug is also used to treat other forms of
Abdominal pain and cramping may also be present.
irritable bowel disease and is safe for long-term use.
The evaluation of patients with persistent diarrhea
In severe cases
a short trial of prednisone may be
requires a medical history review and physical examina-
used. Prednisone, a steroid, usually controls the diarrhea
tion, often including a laboratory analysis of blood and
well, but symptoms may return after tapering its use.
Long-term use of prednisone is limited by side effects
With collagenous colitis, laboratory data is usually
such as high blood pressure, weight gain, cataracts, body
normal. Tissue samples, or biopsies, must be obtained
through a colonoscopy and examined under a microscope.
An effective alternative to prednisone is a newer form
Ultimately, a physician who is trained to examine biopsies, of steroid called budesonide (Entocort). Since this drug, known as a pathologist, makes the diagnosis.
which is also used to treat Crohn’s disease, has minimal ab-
The biopsy of collagenous colitis reveals the thickening
sorption into the bloodstream, side effects are uncommon.
of a band of protein called collagen inside the lining of
Although collagenous colitis is not progressive or fatal,
the colon. White blood cells, called lymphocytes, signifi-
the disease can be quite disabling. Some people quickly
cantly infiltrate the colon lining. Another disease known
respond to treatment, and their symptoms never return.
as lymphocytic colitis differs from collagenous colitis only
For most people, however, symptoms come and go, and
in that it lacks the thickened collagen. These two diseases
continuous treatment is often required.
are also referred to as microscopic colitis because the
inflammation can only be diagnosed with a microscope.
Michael W. Goodman, M.D., is a gastro-
enterologist. His office is located at
Erlanger Medical Mall on the Baroness
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870 Market Street, Suite 570San Francisco, CA 94102(415) 392-6257 Listening to Gender Variant Children: A Humanistic Strategy for Advocates Shannon Minter, Legal Director (Speech given March 11, 2002 at Hunter College School of Social Work in New York, NY) I am very honored to be here. I want to thank the organizers of this wonderful conference, and I especially want to thank Gary Mallon.