American Board of Internal Medicine (ABIM) Certification Practice Exam

What are the options for treating moderate microscopic colitis?

1. Antibiotics or surgery

2. Withdrawal of drugs or bismuth subsalicylate

3. Increased fiber intake or corticosteroids

4. Immunotherapy or probiotics

The correct answer is: Withdrawal of drugs or bismuth subsalicylate

Moderate microscopic colitis is often characterized by chronic, non-bacterial diarrhea and is typically responsive to a variety of treatments aimed at managing symptoms and underlying causes. One of the most effective strategies involves the withdrawal of any potential offending medications, particularly nonsteroidal anti-inflammatory drugs (NSAIDs) or proton pump inhibitors, which have been implicated in the development of this condition. In addition to medication withdrawal, bismuth subsalicylate can be beneficial as it helps to reduce diarrhea and may have anti-inflammatory properties. These approaches are generally the first-line recommendations for treating moderate microscopic colitis as they target both the management of symptoms and the potential underlying causes of the condition without resorting to more invasive treatments. Other treatment options, such as increased fiber intake, may not be as effective in this specific context, and corticosteroids, while used in certain inflammatory bowel diseases, are not typically the initial treatment for microscopic colitis due to their more significant side effects and the milder nature of colitis when compared to more severe forms of bowel inflammation.