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Microsoft powerpoint - 9-10 pardi [compatibility mode]

*This program is supported by Salix. Neither Mayo • Microscopic colitis used as umbrella term -subsets collagenous, lymphocytic colitis • Unclear if distinct or parts of a spectrum Which of the following is true regarding
patients with microscopic colitis?
A) Abdominal pain is uncommon
B) Weight loss is uncommon
C) Fecal leukocytes are uncommon
D) Most meet Rome criteria for IBS
Which of the following is true regarding
patients with microscopic colitis?
A) Abdominal pain is uncommon
B) Weight loss is uncommon
C) Fecal leukocytes are uncommon
D) Most meet Rome criteria for IBS
• Constant or intermittent watery diarrhea • 50% with abdominal pain, mild weight loss • Arthralgias, autoimmune disorders, sprue
– 28-65% in secondary analysis of RCTs2 1) Limsui IBD 2007 2) Madish World J Gastro 2005 • Association with NSAIDs and other meds Which of the following is true regarding the
epidemiology of
microscopic
colitis?
A) Incidence less common t
Crohn’s
B) It is about as common as IBS
C) The incidence
incidence is increasing significantly
D) It accounts for 30-40% of watery diarrhea
Which of the following is true regarding the
epidemiology of
microscopic
colitis?
A) Incidence less common t
Crohn’s
B) It is about as common as IBS
C) The incidence
incidence is increasing significantly
D) It accounts for 30-40% of watery diarrhea
• Female predominance (CC>LC in most) 1998-2001
NSAIDs and other drugs
• Abnormal fluid/salt secretion/absorption • Abnormal collagen synthesis/degradation – acarbose, aspirin, NSAIDs, PPI, SSRI, The best treatment for severe microscopic
colitis is:
A) Loperamide
B) 5-aminosalicylate
C) Budesonide
D) Prednisone
E) Azathioprine
The best treatment for severe microscopic
colitis is:
A) Loperamide
B) 5-aminosalicylate
C) Budesonide
D) Prednisone
E) Azathioprine
• Consider drug-induced microscopic colitis – If any doubt, stop drug and observe diarrhea 1) Baert, Gastro 2002 2) Miehlke, Gastro 2002 3) Bonderup, Gut 2003 4) Miehlke, DDW 2007 During 16 month median f/u of a budesonide RCT coh • 34 pts, 9 mg/d x 6 wks, remission 87% • Relapse: 23% budesonide, 88% placebo • Relapse: 13% budesonide, 61% placebo • Relapse 25%, all successfully retreated • Remission 85% in LC (+ or – cholest.) 1) Pardi Am J Gastro 20022) Olesen Gut 20043) Bohr Gut 1996 • BSS: N=12, response 92%; mean time to response 2
Mesalamine: N=81, ~3 gm/d, response
AZA: N=9, steroid refractory or dependent; response
Methotrexate: N = 19, 7.5-10 mg PO QWk; response
‘good’ in 74%, ‘partial’ in 11% 6 1) Fine, Gastro 1998 2) Fernandez-Banares, AJG 20033) Pardi, Gastro 2001 4) Riddell, J Gastro Hep 2007 Recommended Treatment Approach
D/C NSAIDs, other drugs, dairy products
tidiarrhea
Bismuth subsalicylate
Cholestyramine
Budesonide
Aminosalicylates
Prednisone
Azathioprine / 6-MP
CP999375-2
Microscopic colitis is relatively common cause of diarrhea Consider celiac disease if suggestion of steatorrhea or

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