Budesonide in collagenous colitis: A double-blind placebo-controlled trial with histologic follow-up

Diagnosis and management of microscopic colitis

“…Three short-term, randomized controlled trials in CC have consistently shown that budesonide 9 mg daily for 6-8 wk is superior to placebo (Table 2) [91][92][93] . About 80% of patients responded to budesonide and had a decrease in the number of loose stools after 2-4 wk of therapy.…”

“…The relapse rate is high after cessation of successful short-term budesonide therapy in CC and 61%-80% of treated patients will have a recurrence of symptoms [91][92][93] . In clinical practice, tapering doses of budesonide to 3-6 mg/d have been used as maintenance therapy and may well control clinical symptoms.…”

Collagenous colitis in children and adolescents: study of 7 cases and literature review

“…These findings are consistent with the previously reported intraepithelial lymphocytosis in terminal ileum in adult patients with CC. 26,27 While clinical trials have shown the efficacy of budesonide treatment in adult patients with CC, [28][29][30][31][32] treatment for children appears to be largely empiric with various agents (Table 1). Overall, sulfasalazine, mesalazine, and cholestyramine were either ineffective or only partially effective.…”

The Differential Diagnosis of Colitis in Endoscopic Biopsy Specimens: A Review Article

“…Although it may seem intuitive that the intensity of symptoms correlates with the thickness of the collagen layer, this is in fact not the case. 18,19 Biopsies obtained from the rectum and sigmoid colon may show less thickening and may be in the normal range. When in doubt, particularly in those cases with only minimal or very patchy subepithelial collagen, a trichrome stain can be helpful to highlight the collagenous band and the irregular strands of collagen along its lower border ( Figure 5, B and C).…”

“…Most patients, however, will require some form of therapy, and several trials have confirmed the effectiveness of budesonide over placebo in CC. [19][20][21] The histologic response to therapy is variable, but a decrease in the subepithelial collagen layer as well as the lymphoplasmacytic infiltrate in the lamina propria is found in about half of the patients. 22 The usual response requires approximately 2 weeks, but relapse is frequent when budesonide is discontinued.…”