American Board of Internal Medicine (ABIM) Certification Practice Exam

In the treatment of severe microscopic colitis, which medication is often the first choice?

1. Azathioprine

2. Budesonide

3. Antibiotics

4. Proton pump inhibitors

The correct answer is: Budesonide

Budesonide is often the first choice in the treatment of severe microscopic colitis due to its properties as a corticosteroid that can effectively reduce inflammation and promote mucosal healing in the gastrointestinal tract. Microscopic colitis is characterized by chronic diarrhea and inflammation that is often not evident during standard colonoscopy, so managing the underlying inflammation is crucial in alleviating symptoms. Budesonide is preferred because it is a locally acting steroid, which means it can provide anti-inflammatory effects in the intestines while minimizing systemic side effects that are commonly associated with other corticosteroids. Its controlled release formulation allows for effective delivery to the distal areas of the intestine, which is particularly beneficial in addressing the inflammation seen in microscopic colitis. Additionally, the short-term use of budesonide can lead to rapid symptom relief, making it a suitable first-line option for patients experiencing severe symptoms. While other treatments such as azathioprine or antibiotics may be beneficial in specific situations or cases of refractory disease, they are typically not the first-line options for initial treatment compared to budesonide.