Is sulfasalazine the only known treatment for collagenous colitis?

The disorder you asked about, collagenous colitis, is a rare but treatable inflammatory disorder of the colon. It is characterized by chronic watery diarrhea (sometimes up to 30 times per day), which might lead to dehydration weakness, malnutrition from not being able to eat properly, bloating, and occasional nausea. About half of patients report that these symptoms occur suddenly, with little warning.

During an episode, certain foods — especially those high in fiber and high in fat, dairy products, various spices, and uncooked fruits and vegetables — might be triggers. Although, research has shown little evidence of a link between food and collagenous colitis. Those at highest risk for developing collagenous colitis are males over the age of 40, but cases have been reported in children as young as seven.

Diagnosis is often reached through a process of elimination. Most cases are diagnosed because there is little damage in the intestine shown during an endoscopic examination (which eliminates other disorders, such as Crohn's disease or celiac sprue) and the diagnosis of a band of collagen in the biopsied cells of the colon.

Several medicines have been found to be effective in treating collagenous colitis. Successful clinical trials have included the use of medicines such as budesonide, aminosalicylates, prednisone, metronidazole, cholestyramine, and bismuth subsalicylate.

It is also suggested that patients avoid using any non-steroidal anti-inflammatory medicines (NSAIDs such as ibuprofen), because of a possible link between patients taking NSAIDs for their arthritis-like symptoms and onset of collagenous colitis.

The symptoms associated with collagenous colitis can be treated with anti-diarrheal drugs such as loperamide. If loperamide does not control the symptoms, bismuth subsalicylate is sometimes added. Budesonide might also be prescribed for serious chronic cases. About 25 percent of patients will require long-term therapy because symptoms will resurface if treatment is stopped.

Surgery is a radical approach and is seldom used, except in extremely severe cases. As with any condition, you should discuss your treatment options with your doctor.