American Board of Internal Medicine (ABIM) Certification Practice Exam

When might a bile salt binder be considered in the treatment of microscopic colitis?

1. In all patients

2. For those not responding to budesonide

3. When a patient has acute symptoms

4. As a first line treatment

The correct answer is: For those not responding to budesonide

A bile salt binder may be considered in the treatment of microscopic colitis, particularly for those who do not respond to budesonide, which is a corticosteroid often used as a first-line treatment for this condition. Microscopic colitis is generally characterized by chronic diarrhea, and budesonide is known to effectively manage inflammation in this condition. However, if a patient does not show improvement with budesonide therapy, adding a bile salt binder can help manage symptoms, especially if bile acid malabsorption is contributing to diarrhea. This approach provides an alternative mechanism to help control symptoms and address underlying issues related to bile salts. The use of bile salt binders can also be beneficial in patients who may have bile acid diarrhea as a contributing factor to their symptoms. In contrast, it is not feasible to use a bile salt binder in all patients or as a first-line treatment, as individual responses to therapies can vary. Moreover, acute symptoms often require immediate intervention that may not rely solely on bile salt binders, further underscoring the specific scenario in which these binders would be indicated.