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Forum Name: Gastroenterology Topics

Question: Microscopic Colitis Treatment


 jstoonb - Thu Aug 16, 2007 12:40 am

I posted earlier about the Asacol not really working as well as I'd hoped, and finding full tablets in the stool.

My doctor gave me an Rx for Pentasa. I realize this is the same class of drugs as Asacol. This drug has made no difference and it feels like I'm not even getting treated at all. My symptoms are back to how they were before I was put on Asacol.

My question stems from my research I've done on my own. I have read that the course of treatment does not usually start with these 5-aminoASA drugs and was wondering why I wasn't put on bismuth salicylate tablets. The studies I have read dealing with treatment of Microscopic Colitis have shown that treatment with bismuth salicylate tablets yield a high number of patients who resolve the diarrhea, and do not relapse.

Is this drug OTC, or do I need a prescription? I realize it is the active ingredient in Pepto Bismal, but I would like the tablets.

Do you suggest trying this course of treatment? I've had this diarrhea for almost a year and I'm at the end of my ropes...
 Dr. Chan Lowe - Tue Aug 28, 2007 11:09 pm

User avatar Hi Jstoonb,

Pepto-Bismol is Bismuth Subsalicylate. It is essentially the same as bismuth salicylate. Pepto-Bismol can be obtained in tablet form.

If the Asacol and Pentasa haven't helped much I'm not sure how much the bismuth will help. The mechanism of action is actually essentially the same in these medicines. Asacol is dimerized salicylate so it doesn't get absorbed into the body but still works like salicylate.

There are some other medications that can help with these inflammatory conditions as well. Tumor Necrosis Factor inhibitors such as Remicaid can be helpful in some cases. Several other immune modulators are available also.

I would recommend you see a GI specialist and discuss the issue of these salicylate type medicines not working for you and if the treatments should be scaled up a bit. I would not recommend starting a treatment with bismuth without discussing it with your doctor first.

Best wishes.

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