Rivière P, Zerbib F
Service d'Hépato-gastroentérologie et Oncologie digestive, Centre Médico-chirurgical Magellan, CHU de Bordeaux, 33600 Pessac, France.
Service d'Hépato-gastroentérologie et Oncologie digestive, Centre Médico-chirurgical Magellan, CHU de Bordeaux, 33600 Pessac, France.
Rev Med Interne. 2020 Aug;41(8):523-528. doi: 10.1016/j.revmed.2020.05.022. Epub 2020 Jul 14.
Microscopic colitis is frequently found as a cause of chronic watery diarrhea in women after menopause. The disease can be associated with a medication side effect in half of the patients (non-steroidal anti-inflammatory drugs or proton pump inhibitors for instance). Colonic biopsies are mandatory for the diagnosis of microscopic colitis and should be performed in several locations of the colon. Management of microscopic colitis is first based on avoiding iatrogenic factors and smoking together with symptomatic treatment of diarrhea (loperamide, cholestyramine). In case of failure or severe symptoms, budesonide is the key treatment. The aim of the treatment is to achieve clinical remission, defined as less than 3 liquid stools per day, to improve quality of life. After a first course of budesonide, recurrence of diarrhea is frequent and a maintenance therapy can be prescribed for several months. In case of intolerance or refractoriness, second-line therapy (immunosuppressants, biological therapy, surgery) should be discussed in multidisciplinary team meeting.
显微镜下结肠炎常被发现是绝经后女性慢性水样腹泻的病因。该疾病在半数患者中可能与药物副作用有关（例如非甾体抗炎药或质子泵抑制剂）。结肠活检是诊断显微镜下结肠炎的必要手段，应在结肠的多个部位进行。显微镜下结肠炎的治疗首先基于避免医源性因素和吸烟，同时对腹泻进行对症治疗（洛哌丁胺、考来烯胺）。如果治疗失败或症状严重，布地奈德是关键治疗药物。治疗的目标是实现临床缓解，即每天排便少于3次稀便，以提高生活质量。在首个布地奈德疗程后，腹泻复发很常见，可以开几个月的维持治疗药物。如果出现不耐受或难治性情况，应在多学科团队会议上讨论二线治疗（免疫抑制剂、生物治疗、手术）。
