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ICalming getting back to normal To control diarrhea,
over-the-counter medication such as Lomotil (also known as diphenoxylate and atropine sulfate) or Imodium (loperamide) is often recommended. Though sometimes helpful, these agents usually just delay the diarrhea. Occasionally, bulk-forming agents such as It's an embarrassing topic that we don't like to discuss, but Metamucil and Citrucel or cholesterol-binding agents it happens to everyone from time to time: diarrhea.
(Questran, Welchol, Colestid) may be useful. Some A major cause of chronic diarrhea that lasts more than patients report that eight chewable Pepto-Bismol three weeks is the inflammation of the colon or large tablets per day are effective in taming collagenous intestine, known as colitis. Two types of colitis-ulcerative colitis. However, these medications do not treat the colitis and Crohn's disease-are the most common types of underlying disease. Treating collagenous colitis requires inflammatory bowel disease. However, a third type of colitis drugs that reduce inflammation.
called collagenous colitis is diagnosed with increasing fre-quency. No definite cause of collagenous colitis is known.
What is colitis, and how do i know if i have it? Most individuals with collagenous colitis complain of For mild to moderate symptoms (less than six bowel
chronic, watery, nonbloody diarrhea, which may be con- movements per day), the first line of medical treatment is tinuous or episodic. Diarrhea may be mild (two to three usually mesalamine (Asacol, Pentasa), an anti-inflammatory daily bowel movements) or severe (more than 0 daily). agent that reduces inflammation within the inner lining of Severe cases can lead to weakness and dehydration. the colon. This drug is also used to treat other forms of Abdominal pain and cramping may also be present. irritable bowel disease and is safe for long-term use. The evaluation of patients with persistent diarrhea In severe cases a short trial of prednisone may be
requires a medical history review and physical examina- used. Prednisone, a steroid, usually controls the diarrhea tion, often including a laboratory analysis of blood and well, but symptoms may return after tapering its use. Long-term use of prednisone is limited by side effects With collagenous colitis, laboratory data is usually such as high blood pressure, weight gain, cataracts, body normal. Tissue samples, or biopsies, must be obtained through a colonoscopy and examined under a microscope. An effective alternative to prednisone is a newer form Ultimately, a physician who is trained to examine biopsies, of steroid called budesonide (Entocort). Since this drug, known as a pathologist, makes the diagnosis.
which is also used to treat Crohn's disease, has minimal ab- The biopsy of collagenous colitis reveals the thickening sorption into the bloodstream, side effects are uncommon. of a band of protein called collagen inside the lining of Although collagenous colitis is not progressive or fatal, the colon. White blood cells, called lymphocytes, signifi- the disease can be quite disabling. Some people quickly cantly infiltrate the colon lining. Another disease known respond to treatment, and their symptoms never return. as lymphocytic colitis differs from collagenous colitis only For most people, however, symptoms come and go, and in that it lacks the thickened collagen. These two diseases continuous treatment is often required.
are also referred to as microscopic colitis because the inflammation can only be diagnosed with a microscope. Michael W. Goodman, M.D., is a gastro-
enterologist. His office is located at
Erlanger Medical Mall on the Baroness
Campus (423-267-5677).

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