Collagenous colitis (CC) causes diarrhoea, increased collagen layer thickness and bile acid malabsorption (BAM). There is evidence of a noxious factor in the faecal stream. It was proposed that bile acid might be this noxious factor and treatment with budesonide and colesevelam could break the CC / BAM vicious circle.
It was possible to taper down budesonide therapy whilst using colesevelam to protect the gut from bile acids. This resulted in a complete cure with no need for further medication.
Protecting the gut form BAM whilst tapering down budesonide therapy was a successful strategy. I suggest patients ask their gastroenterologist if they can trial this therapy.
Some patients with severe CC need an ileostomy because budesonide therapy isn’t effective. They may be able to avoid surgery by using combined budesonide / colesevelam therapy.