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Suggest Treatment For Collagenous Colitis
Question: Hello,
I'm a Flight Attendant who flies long-haul flights from East Coast to Europe. I have collagenous colitis. How can I stop flatulence in flight. I live with Immodium AD and Pepto Bismol. I come home feeling like I m look pregnant. I've never been pregnant. I also have charcoal pills and drink at least one liter of water throughout the flight, and, also on my 24 hour layover. I'm 57 years old.
Can you help me, please?
I'm a Flight Attendant who flies long-haul flights from East Coast to Europe. I have collagenous colitis. How can I stop flatulence in flight. I live with Immodium AD and Pepto Bismol. I come home feeling like I m look pregnant. I've never been pregnant. I also have charcoal pills and drink at least one liter of water throughout the flight, and, also on my 24 hour layover. I'm 57 years old.
Can you help me, please?
Brief Answer:
options explained..
Detailed Answer:
hello and welcome.
I really appreciate you concern.
The Treatment should be initiated with the least toxic regimen or medication, with stronger medication used only if milder treatment fails. Generally, 4-6 weeks should be allowed before deeming a particular medication ineffective in the treatment of CC or LC.
•First line: Loperamide (Imodium AD) or diphoxylate/atropine (Lomotil) for mild diarrhea.
•Second line: Bismuth subsalicylate months (effective in up to 90% of patients); mesalamine or cholestyramine (especially if bile acid malabsorption is documented)
•Third line: If patient is still not responding or if a patient has clinically more severe colitis, a 6-week course of budesonide at the lowest effective dosage. Longer courses of budesonide may be beneficial, and, while systemic adverse effects may occur, little or no adrenal suppression should be anticipated. Clinical remission and improved histology is achieved in a majority of patients with lymphocytic colitis when treated with budesonide.
•Fourth line: Some refractory cases may benefit from azathioprine but responses often take months to occur. Methotrexate can alternatively be used in this setting.
•If colitis is refractory to continued medical therapy or if effective medication cannot be tolerated, colectomy or ileostomy might be the only effective therapy
Anti spasmodic meds like HYOSCYAMINE can help in the flatulence, if you feel that your abdomen is disproportionately enlarged then please get an ultra sound abdomen and pelvis done in consult with your doctor.
More than half of patients treated for LC experienced resolution of symptoms after 6 months of treatment, while only 15% of patients had significant persistent symptoms.
In some patients, the diarrhea may wax and wane over many years; however, more than 80% of patients can expect diarrhea and histologic abnormalities to resolve within 3 years.
Although some small studies have suggested otherwise, microscopic colitis (either CC or LC) does not appear to increase the risk of colon cancer, though I would still advise a colonoscopy every 10 years, considering your age and risk factors.
let me know if you have any query
I will be more than glad to answer
thanks
options explained..
Detailed Answer:
hello and welcome.
I really appreciate you concern.
The Treatment should be initiated with the least toxic regimen or medication, with stronger medication used only if milder treatment fails. Generally, 4-6 weeks should be allowed before deeming a particular medication ineffective in the treatment of CC or LC.
•First line: Loperamide (Imodium AD) or diphoxylate/atropine (Lomotil) for mild diarrhea.
•Second line: Bismuth subsalicylate months (effective in up to 90% of patients); mesalamine or cholestyramine (especially if bile acid malabsorption is documented)
•Third line: If patient is still not responding or if a patient has clinically more severe colitis, a 6-week course of budesonide at the lowest effective dosage. Longer courses of budesonide may be beneficial, and, while systemic adverse effects may occur, little or no adrenal suppression should be anticipated. Clinical remission and improved histology is achieved in a majority of patients with lymphocytic colitis when treated with budesonide.
•Fourth line: Some refractory cases may benefit from azathioprine but responses often take months to occur. Methotrexate can alternatively be used in this setting.
•If colitis is refractory to continued medical therapy or if effective medication cannot be tolerated, colectomy or ileostomy might be the only effective therapy
Anti spasmodic meds like HYOSCYAMINE can help in the flatulence, if you feel that your abdomen is disproportionately enlarged then please get an ultra sound abdomen and pelvis done in consult with your doctor.
More than half of patients treated for LC experienced resolution of symptoms after 6 months of treatment, while only 15% of patients had significant persistent symptoms.
In some patients, the diarrhea may wax and wane over many years; however, more than 80% of patients can expect diarrhea and histologic abnormalities to resolve within 3 years.
Although some small studies have suggested otherwise, microscopic colitis (either CC or LC) does not appear to increase the risk of colon cancer, though I would still advise a colonoscopy every 10 years, considering your age and risk factors.
let me know if you have any query
I will be more than glad to answer
thanks
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Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Answered by
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