Before you’re offered any treatment for Microscopic Colitis your doctor will review the medicines you already take for other conditions. Medicines that may trigger Microscopic Colitis include:  

• non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, diclofenac
• some proton pump inhibitors (PPIs) such as omeprazole and lansoprazole used to reduce stomach acid
• selective serotonin reuptake inhibitors (SSRIs) used to treat depression
• aspirin
• acarbose for diabetes
• ranitidine for indigestion and heart burn
• ticlopidine for blood conditions
• statins for cholesterol control.

Many of these medicines can also cause diarrhoea as a side effect. But if you're taking any of these do not stop taking them until you’ve talked to your doctor. 

Lifestyle changes

Cutting down alcohol and caffeine can be helpful in reducing diarrhoea. It’s often useful to keep a record of when you stop or cut down and how your symptoms change.

• Try cutting down on caffeine – drink decaffeinated tea, coffee, soft drinks or water and reduce the amount of chocolate you eat.
• Cut down alcohol – drinking less has been shown to help symptoms.
• Stop smoking - smoking increases the risk of Microscopic Colitis, and people who smoke have symptoms which are worse and less likely to get better with treatment. Your GP practice can offer support with stopping smoking.  

Medicines

There may be several options for treatment depending on the severity of the symptoms you have.

• Loperamide. If you have mild Microscopic Colitis, medicines to stop diarrhoea, such as loperamide, can be effective. These slow down muscle contractions of the gut which makes food move through more slowly and allows more water to be absorbed. Poo becomes firmer and less urgent. They can also help to control symptoms whilst other medications take time to work.
• Bile Acid Sequestrants. These include colestyramine, colestipol or colesevelam. If Microscopic Colitis is related to bile acid malabsorption (BAM), or you continue to have diarrhoea despite other treatment, you may be offered this type of medicine.  These bind to the bile acids in your gut and help to improve symptoms of diarrhoea. It has been suggested that this may be effective even where BAM isn’t present. 
• Budesonide. This steroid has been found to be an effective treatment if you have moderate to severe Microscopic Colitis. Around 8 out of 10 people have been shown to improve when taking this medicine and there are usually few side effects. 

Most people get better with these approaches but if they don’t work for you other treatments may be tried.

• Biologic Medicines. Infliximab and adalimumab have been shown in small studies to improve symptoms for some people where budesonide hasn’t been effective. Small studies also suggest that vedolizumab could be helpful.
• Immunosuppressants. Azathioprine and mercaptopurine have been shown to be effective for some people where budesonide hasn’t worked.

Surgery

Surgery is very rarely needed, but for the few people where other approaches haven’t been successful this can be an option.