P0318 - Role of Azathioprine as an Effective Alternative Therapy for Patients With Refractory Microscopic Colitis

Aliza Rizwan, MD¹, Yousuf Siddiqui, MD², Syed-Mohammed Jafri, MD^3
1Henry Ford Health, Northville, MI; ²Henry Ford Health, Sterling Heights, MI; ³Henry Ford Health, Detroit, MI

Introduction: Microscopic colitis (MC), a common cause of chronic diarrhea encompasses two histological subtypes: Collagenous and Lymphocytic colitis. Collagenous colitis, is chronic inflammation of the colon, causing an excess buildup of collagen, a fibrous protein in the lining of colon that can cause persistent diarrhea. The exact etiology of MC is unclear and is common in older female adults. With rising cases of refractory microscopic colitis; failing first line therapies including anti-diarrheal, budesonide (BDS), anti-tumor necrosis factors [anti-TNFs] and methotrexate. We present a case on effective therapeutic response of Azathioprine (AZA) in a patient with refractory MC.

Case Description/Methods: 86 y/o F with history of MC, Irritable bowel syndrome and sarcoidosis presented with persistent diarrhea despite being on BDS and dietary modifications. Pt underwent colonoscopy with biopsies of distal small bowel, terminal ileum; random colon to rule out inflammation. Biopsy showed irregular thickening of the collagen table, patchy areas of epithelial denudation and increase in mixed chronic inflammatory infiltrate within the lamina propria with prominent eosinophils consistent with collagenous colitis. No evidence of cryptitis, crypt abscess or granulomas were seen. Patient was treated with variety of agents for MC including Bismuth subsalicylate, mesalamine, cholestyramine, prednisone, BDS, Infliximab (INX), Adalimumab (ADA) without resolution of symptoms. Patient had not responded to INX and had a rash with ADA. Patient was started on AZA with good response and symptomatic improvement. Pt remained stable on AZA, without any major issues.

Discussion: An abnormal immune system response in the colon is mainly believed to be the underlying mechanism for MC etiology. Risk factor includes autoimmune disorders, infections, genetic predisposition and certain medications like Non-steroidal anti-inflammatory drugs (NSAIDs). AZA an immunosuppressive medication can be prescribed in refractory cases of MC, which help reduce inflammation and alleviate symptoms associated with MC. As with any medication, AZA also have side effects particularly with long-term use. Side effects of AZA includes nausea, vomiting, liver toxicity, increased risk of infection, certain types of cancer and bone marrow suppression. It is important to weigh the potential benefits against the risks and side effects. AZA can definitely be an option for treating MC with close monitoring especially given rise in cases of refractory MC.


Disclosures:


Aliza Rizwan, MD¹, Yousuf Siddiqui, MD², Syed-Mohammed Jafri, MD³. P0318 - Role of Azathioprine as an Effective Alternative Therapy for Patients With Refractory Microscopic Colitis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.