Case 22.3
You prescribe an 8-week course of budesonide 9 mg daily for 8 weeks, instruct her to stop naproxen but continue aspirin, and encourage smoking cessation. You also recommend taking polyethylene glycol daily along with a fiber supplement for constipation. You repeat a colonoscopy 8 weeks later:
Note: Blood in this photo is due to biopsy
Biopsies from the healed ulcer return with increased lymphoplasmacytic and eosinophilic infiltrate in the lamina propria. Random biopsies of normal-appearing mucosa in the right colon show prominent lymphoid aggregates. Random biopsies of normal-appearing mucosa in the left colon show typical features of collagenous colitis, with increase intraepithelial lymphocytes and a thickened sub-epithelial collagen layer.
She feels much better. She is taking 1.5 capfuls of polyethylene glycol daily and is having soft bowel movements daily. She has stopped using naproxen and has cut down to 1-2 cigarettes per day. She has no more blood in the stools.