Treatment

Microscopic colitis may get better on its own. But when symptoms persist or are severe, you may need treatment to relieve them. Doctors usually try a stepwise approach, starting with the simplest, most easily tolerated treatments.

Diet and discontinuation of medication

Treatment usually begins with changes to your diet and medications that may help relieve persistent diarrhea. Your doctor may recommend that you:

• Eat a low-fat, low-fiber diet. Foods that contain less fat and are low in fiber may help relieve diarrhea.
• Discontinue dairy products, gluten or both. These foods may make your symptoms worse.
• Avoid caffeine and sugar.
• Discontinue any medication that might be a cause of your symptoms. Your doctor may recommend a different medication to treat an underlying condition.

Medications

If signs and symptoms persist, your doctor may recommend:

• Anti-diarrheal medications such as loperamide (Imodium) or bismuth subsalicylate (Pepto-Bismol)
• Steroids such as budesonide (Entocort EC)
• Medications that block bile acids (which can contribute to diarrhea) such as cholestyramine/aspartame or cholestyramine (Prevalite), or colestipol (Colestid)
• Anti-inflammatory medications such as mesalamine (Delzicol, Apriso, others) to help control colon inflammation
• Medications that suppress the immune system to help reduce inflammation in the colon, such as mercaptopurine (Purinethol) and azathioprine (Azasan, Imuran)
• TNF inhibitors, such as infliximab (Remicade) and adalimumab (Humira), which can reduce inflammation by neutralizing an immune system protein known as tumor necrosis factor (TNF)

Surgery

When the symptoms of microscopic colitis are severe, and medications aren't effective, your doctor may recommend surgery to remove all or part of your colon. Surgery is rarely needed to treat microscopic colitis.