American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the first-line treatment for mild persistent microscopic colitis?

1. Antibiotics

2. Budesonide

3. Antidiarrheals

4. Immunosuppressants

The correct answer is: Antidiarrheals

The first-line treatment for mild persistent microscopic colitis is budesonide. Budesonide is a topical corticosteroid that acts locally in the gut to reduce inflammation without significant systemic absorption. This makes it particularly effective for treating conditions like microscopic colitis, which is characterized by chronic diarrhea and underlying inflammation of the colonic mucosa. As it is a corticosteroid, budesonide helps to manage inflammation and promotes remission in patients suffering from the symptoms of this condition. While antidiarrheals may provide symptomatic relief for diarrhea, they do not address the underlying inflammation and are therefore not considered a definitive treatment option. Antibiotics can treat infections but are not effective for microscopic colitis unless there’s a specific infectious cause identified. Immunosuppressants are generally reserved for more severe forms of inflammatory bowel diseases and are not the first choice for mild persistent cases, due to their risk of more significant side effects and the need for monitoring.