Gastroenterology and hepatology: collagenous colitis: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Gastroenterology and hepatology: collagenous colitis

Sample item

A 58-year-old woman on lansoprazole and ibuprofen has 3 months of watery, non-bloody diarrhoea, including at night. Colonoscopy looks normal and CRP is normal. Colonic biopsies show a thickened subepithelial collagen band. Which treatment is most effective?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Oral budesonide

Microscopic colitis is a cause of chronic watery diarrhoea with a normal-looking mucosa, and is linked to NSAIDs and proton pump inhibitors, so these should be stopped if possible. Budesonide induces remission in most patients, though relapse is common after stopping.

Option by option

  • A. Subtotal colectomy

    Colectomy is rarely necessary for this benign condition.

  • B. Infliximab infusions

    Infliximab is reserved for refractory inflammatory bowel disease, not first-line here.

  • C. Oral mesalazine alone

    Mesalazine alone is less effective than budesonide in controlled trials.

  • D. Oral budesonide (correct)

    Correct. Budesonide is the most effective drug for inducing remission.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More General Medicine questions

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is D, Oral budesonide. Microscopic colitis is a cause of chronic watery diarrhoea with a normal-looking mucosa, and is linked to NSAIDs and proton pump inhibitors, so these should be stopped if possible.

Why is "Subtotal colectomy" not the answer?

Colectomy is rarely necessary for this benign condition.

Why is "Infliximab infusions" not the answer?

Infliximab is reserved for refractory inflammatory bowel disease, not first-line here.

Why is "Oral mesalazine alone" not the answer?

Mesalazine alone is less effective than budesonide in controlled trials.

What concept does this question test?

It tests Gastroenterology and hepatology: collagenous colitis in General Medicine. Budesonide induces remission in most patients, though relapse is common after stopping.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Gastroenterology and hepatology: collagenous colitis?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.