American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the role of azathioprine in the management of microscopic colitis?

1. It is used for immediate symptom relief

2. It can be prescribed for long-term maintenance therapy

3. It is a first-line therapy for all cases

4. It is indicated for antibiotic-resistant infections

The correct answer is: It can be prescribed for long-term maintenance therapy

Azathioprine plays a significant role in the management of microscopic colitis, particularly in situations where patients require long-term maintenance therapy. This medication is an immunosuppressant that helps in controlling inflammation by inhibiting the proliferation of lymphocytes, which can be beneficial for individuals who suffer from chronic inflammation associated with microscopic colitis. In practice, while immediate symptom relief can be achieved through other means, such as dietary modifications or the use of anti-diarrheal medications, azathioprine is not typically used for rapid symptom control. Its effects are gradual and usually manifest over weeks to months, making it unsuitable for acute management. Azathioprine is particularly valuable as a long-term strategy for maintaining remission after achieving initial control of the disease with other therapies. This makes it an essential component of the treatment plan for patients who experience persistent symptoms or frequent relapses. In addition, azathioprine is not considered a first-line therapy in all cases of microscopic colitis and is not indicated for treating infections; therefore, its uses are more specialized and targeted towards long-term management of the condition.