Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 15-35: Inflammatory Bowel Disease + Key Features Download Section PDF Listen +++ ++ Chronic or intermittent watery diarrhea with normal-appearing mucosa at endoscopy Much more common in women, especially in the fifth to sixth decades Cause is usually unknown Several medications have been implicated as etiologic agents, including NSAIDs Proton pump inhibitors Low-dose aspirin Selective serotonin reuptake inhibitors Angiotensin-converting enzyme inhibitors Beta-blockers Menopausal estrogen hormone therapy Diarrhea usually abates within 30 days of stopping the offending medication + Clinical Findings Download Section PDF Listen +++ ++ Chronic or recurrent diarrhea May remit spontaneously after many years A more severe illness may develop in a subset of patients and is characterized by Abdominal pain Fatigue Dehydration Weight loss + Diagnosis Download Section PDF Listen +++ ++ Serologic testing (IgA tissue transglutaminase antibody [or IgA tTG]) can exclude celiac disease, which may be present in up to 2–9% of patients Sigmoidoscopy or colonoscopy with biopsy Histologic evaluation of mucosal biopsies shows chronic inflammation in the lamina propria and increased intraepithelial lymphocytes + Treatment Download Section PDF Listen +++ ++ Loperamide First-line treatment Provides symptom improvement in up to 70% Delayed-release budesonide (Entocort EC) 9 mg once daily orally for 6–8 weeks has demonstrated efficacy in controlled studies However, clinical relapse is common after cessation of therapy Remission is maintained in 75% of patients treated long term with low doses In clinical practice, budesonide is tapered to the lowest effective dose for suppressing symptoms (3 mg every other day to 6 mg daily) 5-Aminosalicylates (sulfasalazine, mesalamine) or bile-salt binding agents (cholestyramine, colestipol) may be effective for patients who do not respond to budesonide Immunosuppressive agents (azathioprine or methotrexate) or anti-TNF agents (infliximab or adalimumab) may be given for refractory or severe symptoms (which occur in < 3% of patients)