American Board of Internal Medicine (ABIM) Certification Practice Exam

What treatment option is appropriate for mild symptoms of microscopic colitis?

1. Long-term corticosteroid therapy

2. Antidiarrheals like loperamide or diphenoxylate

3. Human immunoglobulin

4. Probiotics

The correct answer is: Antidiarrheals like loperamide or diphenoxylate

In the context of mild symptoms of microscopic colitis, the use of antidiarrheals such as loperamide or diphenoxylate is considered an appropriate treatment option. Microscopic colitis is typically characterized by chronic, non-bloody diarrhea, and these antidiarrheal medications can effectively reduce the frequency of bowel movements and improve the quality of life for patients experiencing mild symptoms. Antidiarrheals work by slowing down gut motility and enhancing the absorption of fluids in the intestines, resulting in firmer stools and less urgent bowel movements. This symptom relief is particularly useful for individuals with mild cases where the inflammation may not be severe enough to warrant more aggressive treatment strategies. While other treatments like corticosteroids are commonly used in more severe cases of microscopic colitis, they may not be necessary for mild symptoms and certainly come with a risk of side effects associated with long-term use. Meanwhile, human immunoglobulin has no standard role in treating microscopic colitis, making it an inappropriate option in this context. Probiotics may provide some benefit in other gastrointestinal conditions, but their specific effect on microscopic colitis is not as well-established as that of antidiarrheals in managing mild symptoms.