Interventions for treating lymphocytic colitis
Published Online: 23 APR 2008
Assessed as up-to-date: 10 FEB 2008
Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Chande N, McDonald JWD, MacDonald JK. Interventions for treating lymphocytic colitis. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD006096. DOI: 10.1002/14651858.CD006096.pub3.
- Publication Status: Edited (no change to conclusions)
- Published Online: 23 APR 2008
Lymphocytic colitis is a cause of chronic diarrhea. Therapy is based mainly on case series and uncontrolled trials, or by extrapolation of data for treating collagenous colitis, a related disorder. This review was performed to identify therapies for lymphocytic colitis that have been proven in randomized controlled trials.
To determine effective treatments for patients with clinically active lymphocytic colitis.
The MEDLINE, PUBMED and EMBASE databases were searched using the search criteria "microscopic colitis" or "lymphocytic colitis" and "treatment" or "therapy" or "management" to identify relevant papers published between 1970 and December 2007. Manual searches from the references of identified papers and relevant review papers were performed. Abstracts from major gastroenterological meetings were searched to identify research submitted in abstract form only. The trial registry website www.ClinicalTrials.gov was searched to identify registered but unpublished trials. Finally, the Cochrane Central Register of Controlled Trials and the Cochrane Inflammatory Bowel Disease and Functional Bowel Disorders Group Specialized Trials Register were searched for other studies.
Five randomized controlled trials were identified. Three of these studies, which assessed bismuth subsalicylate vs. placebo, budesonide vs. placebo, and mesalazine vs. mesalazine vs. cholestyramine in treating active disease, are included in this review.
Data collection and analysis
Data were extracted independently by each author onto 2x2 tables (treatment versus placebo or active comparator and response versus no response). For therapies assessed in one trial only, P values were derived using the chi-square test.
Forty-one patients were enrolled in the trial studying budesonide (9 mg/day for 6 weeks versus placebo). Budesonide was more effective than placebo at inducing both clinical (P = 0.004; NNT = 3) and histological responses (P = 0.04; NNT = 3). Forty-one patients were enrolled in the study assessing mesalazine versus mesalazine plus cholestyramine. A high proportion of patients in each group responded to treatment. However, no statistically significant difference in clinical response was found between the two treatment groups (P = 0.95). Five patients were enrolled in the trial studying bismuth subsalicylate (nine 262 mg tablets daily for 8 weeks vs. placebo). There were no differences in clinical (P=0.10) or histological responses (P=0.71) in patients treated with bismuth subsalicylate compared with placebo.
A single trial studying budesonide suggests that it may be effective for the treatment of active lymphocytic colitis. An ongoing placebo-controlled trial may confirm the benefit of budesonide. There is weaker evidence that mesalazine with or without cholestyramine may be effective for the treatment of lymphocytic colitis, but this benefit needs to be confirmed in a placebo-controlled study. No conclusions can be made regarding bismuth subsalicylate. These agents require further study before they can be recommended as treatment options for lymphocytic colitis. Further trials studying interventions for lymphocytic colitis are warranted.
Plain language summary
Treatments for lymphocytic colitis
Budesonide is a corticosteroid drug that is quickly metabolized by the liver thereby decreasing drug-related side-effects. This review demonstrates that budesonide may be effective for treating chronic diarrhea associated with lymphocytic colitis over a six week period. There is also weaker evidence that mesalazine with or without cholestyramine may be effective for treating chronic diarrhea associated with lymphocytic colitis over a six month period. These and other agents require further study before they can be recommended as treatment options for lymphocytic colitis.
淋巴球性結腸炎（lymphocytic colitis）是造成慢性腹瀉的原因之一，治療方式主要是根據個案系列和無對照試驗，或者以治療膠狀性結腸炎（Collagenous colitis）的數據推論來決定。本文獻回顧便是希望能夠確認在隨機對照試驗中使用過的淋巴球性結腸炎的治療方法。
搜尋MEDLINE、PUBMED以及EMBASE等資料庫，搜尋條件為：“microscopic colitis”或“lymphocytic colitis”及“treatment”或“therapy”或“management” 以找出於1970年到2006年9月間的相關文章。並且以人工的方式搜尋所找到的文章以及系統性文獻回顧所引用的參考文獻。並且搜尋主要的腸胃道研討會的摘要，以尋找只有摘要形式的研究。最後還搜尋了 Cochrane Central Register of Controlled Trials and Cochrane Inflammatory Bowel Disease and Functional Bowel Disorders Group Specialized Trials Register 以尋找其他研究。
一項使用Bismuth subsalicylate來治療淋巴球性結腸炎的單一研究，推測Bismuth subsalicylate可能是有用的，但是此研究中僅納入5名受試者且試驗規模太小，因此無法獲得可靠的結論，尚需進行大型試驗來探討Bismuth subsalicylate的療效。