Microscopic colitis is a term used for two types of bowel inflammation, collagenous colitis and lymphocytic colitis. Both entities can cause chronic, non-bloody watery diarrhea and abdominal cramping. This array of symptoms can either be continuous or have symptom-free periods. In a study, An association between microscopic colitis and celiac disease by Green PH, Yang J, Cheng J, Lee AR, Harper JW, Bhagat G, the authors state that there is a 70-fold increase in the development of microscopic colitis in a celiac patient. With the large array of celiac patients that I am seeing in my office, I am seeing my fair share of microscopic colitis as well.

  Six months ago, I had one such patient visit my office. She was recently diagnosed with celiac disease and had biopsies done that revealed microscopic colitis. Because of the increased propensity for this condition in celiac patients, I wanted to be well versed on the treatments that are available. One such treatment  is a poorly absorbed steroid called Entocort (Budesonide). Entocort is absorbed mainly in the gastrointestinal tract and to a lesser degree, systemically, so it is more appealing due the lesser array of side effects. I began this patient on Entocort and within one month her diarrhea had completely resolved and she started to gain weight and feel significantly improved. We have already begun the weaning process and she continues to do well.

 On a recent visit with her husband to his colorectal surgeon, she mentioned to him that she was on Entocort for microscopic colitis. He stated to her that this was inappropriate treatment for her condition as it is absorbed strictly in the terminal ileum (the end of the small intestine) and not in the colon. My patient called me distressed over my poor choice of treatments.

 The National Institutes of Health list Entocort as one of the main treatments for microscopic colitis (http://digestive.niddk.nih.gov/ddiseases/pubs/collagenouscolitis/ ), as does Mayo Clinic and MedicineNet.com. It is absorbed both in the small intestine as well as parts of the large intestine.  So, if you are suffering with microscopic colitis and your physician has prescribed Entocort for you, rest assured that you are on the appropriate treatment, no matter what the local surgeon states!