Treatment Of Collagenous Colitis
No cure is yet available. Treatment is directed at reducing inflammation and the symptoms of diarrhea. This usually involves a “trial and error” process as each case is different. With treatment, most symptoms can be controlled. However, when treatment is tapered, the symptoms usually reappear. Most patients, therefore, need continual therapy to control symptoms.
There is no specific diet to follow. Foods containing caffeine or lactose should be excluded from the diet, since they stimulate fluid secretion in the colon. If a patient is unable to digest fats, a low-fat diet may be helpful. Nonsteroidal anti-inflammatory drugs should be avoided, since studies have suggested that they may be associated with collagenous colitis.
The first line of medical treatment is usually anti-inflammatory agents that reduce inflammation within the inner lining of the colon. These drugs are also used to treat other forms of IBD and are safe for long term use. In severe cases, a short trial of a steroid drug may be used to reduce symptoms. But side effects usually limit long term use. A newer form of steroid has been helpful with fewer side effects. Entocort remains mostly in the intestinal tract and is not absorbed as much into the bloodstream so systemic side effects are less common. It was developed for patients with Crohn’s colitis, but has been shown to be helpful in some patients with collagenous colitis.
High dose Pepto-bismol is sometimes tried as an alternative agent usually given as eight chewable tablets daily for eight weeks. Research done suggests this can be quite effective in some patients.
To treat diarrhea, drugs are often prescribed. Paradoxically, some patients respond to fiber supplements such as Metamucil (psyllium) or Citrucel (methylcellulose). These agents are usually recommended for treatment of constipation when they are taken with large amounts of water. However, when taken with small amounts of water, these agents can absorb excess fluid within the colon and help to firm up loose stools.
