Efficacy of open-label bismuth subsalicylate for the treatment of microscopic colitis.
OBJECTIVE
The pathogenesis of the microscopic colitis syndrome is unknown but may involve bacteria, an intestinal luminal antigen, and/or autoimmunity. It was hypothesized that bismuth subsalicylate would resolve both diarrhea and colonic inflammation in microscopic colitis because it possesses antidiarrheal, antibacterial, and anti-inflammatory properties.


METHODS
Thirteen patients with microscopic colitis (7 with subepithelial collagen deposition and 6 without) were treated with eight chewable 262-mg bismuth subsalicylate tablets per day for 8 weeks. Patients recorded the frequency of bowel movements daily. Forty-eight-hour stool collections and flexible sigmoidoscopy with 24 biopsies were performed before and after treatment in each patient.


RESULTS
Twelve patients completed the trial. Eleven patients had a resolution of diarrhea and a reduction in fecal weight. The average time to respond was 2 weeks. In 9 patients, colitis resolved. When present before treatment, subepithelial collagen thickening disappeared. Those completing the trial experienced no side effects. Posttreatment follow-up for 7-28 months shows that 9 patients remain well having undergone no further treatment, 2 are well but required retreatment, and 1 has continued diarrhea.


CONCLUSIONS
Bismuth subsalicylate treatment for 8 weeks is safe and well tolerated. This regimen appears to be efficacious for the treatment of microscopic colitis and is worthy of further study in a controlled trial.
Fine
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KD
Division of Gastrointestinal Research, Baylor University Medical Center, Dallas, Texas, USA.
Lee
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EL
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D001729:Bismuth / Q000008:administration & dosage* / Q000009:adverse effects; D003092:Colitis / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds / Q000008:administration & dosage* / Q000009:adverse effects; D012459:Salicylates / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome
D009942:Organometallic Compounds; D012459:Salicylates; C015715:bismuth subsalicylate; D001729:Bismuth