Therapy of prednisone-refractory collagenous colitis with budesonide

Collagenous colitis is a rare cause of chronic watery diarrhea. No effectiv e standard treatment has yet been established. Based upon anecdotal reports some antiinflammatory and symptomatic drugs seem to have some therapeutic efficacy. Prednisone is widely believed to be the most effective treatment. Here we describe three female patients with histologically confirmed colla genous colitis refractory to therapy with prednisone. Each had received pre dnisone with a high starting bolus and lower dose maintenance therapy for t heir disease. However, definite clinical remission could not be achieved. A fter the administration of 3x3 mg/day controlled ileal release (CIR) capsul es of budesonide the symptoms resolved immediately. The mean follow-up afte r beginning budesonide was 11 months (range 7-18). Two patients are still o n budesonide. One had had a quick relapse of diarrhea after stopping her tr eatment. Budesonide therapy was therefore resumed. She has remained symptom -free on a lower daily dose of 2x3 mg/day budesonide. One patient has been in remission for more than 1 year after a 3-month course of budesonide. Bud esonide is a topically acting steroid with rapid absorption, high receptor affinity, and low systemic bioavailability, thus causing almost no side eff ects. As yet only few case reports have been published on the use of budeso nide for collagenous colitis. We present here the first three cases of pred nisone refractory collagenous colitis successfully treated with budesonide.