Dear Dr. Roach: I have had microscopic colitis since 2013 and have been prescribed 3 mg of Entocort every day. I have some good days but mostly not-so-good days.
Changing my diet does not seem to help, and I have been advised that this problem will continue for the rest of my life. I am now 77 years old and of average weight. I have a glass of wine periodically and do not smoke.
With different treatments now available, is there something that could be suggested for me? I have not been able to travel to see family since 2013 and am mostly housebound, as I cannot travel very far at all. Accidents happen, and that makes me more cautious of travel.
R.T.
Microscopic colitis can refer to one of two types: lymphocytic colitis and collagenous colitis. As the “itis” in the name suggests, it is characterized by inflammation. The rest of the name lets you know the inflammation is in the colon.
Unlike Crohn’s disease — another type of inflammatory bowel condition — microscopic colitis does not have disease that’s visible with endoscopy. The main symptom of microscopic colitis is chronic, non-bloody, watery diarrhea, usually five to 10 times per day, but sometimes far more. Abdominal pain and weight loss often occur.
Budesonide (Entocort) is a powerful steroid anti-inflammatory that is not absorbed by the body, so it remains active all the way through the intestinal tract into the colon. It is often very effective, but if you are having more not-so-good days than good days, it is certainly time to consider alternatives.
The first thing to consider is whether the diagnosis might have been wrong. Early Crohn’s disease can look very much like microscopic colitis. Irritable bowel syndrome has a lot of overlap with microscopic colitis. Celiac disease has often been mistaken for microscopic colitis. It might be time for another careful look, including biopsies and blood testing for celiac if you have not had that. Hyperthyroidism, drug toxicity (especially anti-inflammatories like ibuprofen) and secretory tumours all can mimic microscopic colitis.
If it is microscopic colitis, cholestyramine is a very effective additional treatment for diarrhea in people with fairly mild, persistent symptoms. People with persistent severe symptoms may need more potent therapy, such as infliximab or 6-MP. An expert, preferably a gastroenterologist with special expertise in inflammatory bowel disease, is the ideal consultant for this condition.
Dear Dr. Roach: My wife, age 80, has a breathing problem. In the past four years, she has had to stop and catch her breath after walking only 10-15 feet. If she sits, she has no problem. Numerous doctors have done nothing.
A.G.
That’s a big problem. There are three major organs that cause this degree of shortness of breath on exertion: the heart, the lungs and the blood.
Blockages in the heart or a muscle problem of the heart itself (congestive heart failure) are two common causes of heart-related shortness of breath. Any severe lung disease will cause breathing problems with exertion. There are many, but the most common are the chronic obstructive pulmonary diseases, like emphysema. Finally, a very severe anemia can mimic these problems.
Her doctor should not be ignoring this. Tests for the heart, lungs and blood are easily done and can usually identify where the problem might be.
I have occasionally had patients who exercise so little that their heart becomes “deconditioned,” and an exercise program that starts with minimal effort and builds up slowly is indicated after other, more serious diseases are excluded.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
