• Thomas G Cotter, Amrit K Kamboj, Stephen Bradley Hicks, William J Tremaine, Edward V Loftus, and Darrell S Pardi.
• aDepartment of Internal Medicine bDivision of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
• Medicine (Baltimore). 2017 Nov 1; 96 (46): e8355.

RationaleMicroscopic colitis is a common cause of diarrhea. Pentoxifylline, a xanthine derivative with anti-tumor necrosis factor-alpha properties, is prescribed for intermittent claudication and other disorders. Our goal was to evaluate the outcomes of patients with microscopic colitis treated with pentoxifylline.Patient ConcernsNine patients with microscopic colitis (8 collagenous colitis and 1 lymphocytic colitis) seen at Mayo Clinic, Rochester, between January 1, 1997 and November 30, 2016, were included. The median age was 56.9 years (range 51.6-60.2), 8 were female (89%), and the median disease duration was 64.8 months (range 60-109). The indications for treatment were budesonide refractoriness in 7 patients, budesonide dependence in 1 patient, and budesonide intolerance in 1 patient.DiagnosesA histological diagnosis of microscopic colitis was confirmed in all patients.InterventionsPentoxifylline 400 mg three times a day was used for a median of 3 months (range 2.5-8.3).OutcomesComplete response occurred in 1 patient (11%) and partial response in 3 patients (33%). The patient who achieved complete response was treated with pentoxifylline due to budesonide intolerance, and completed 43 months of successful maintenance therapy. There were no adverse effects reported.LessonsThe majority of budesonide-experienced patients with active microscopic colitis did not respond to pentoxifylline. However, it was well-tolerated, with 1 patient achieving long-term remission and one-third of the cohort having a partial response. Larger controlled studies are required to evaluate the efficacy of pentoxifylline and predictors of response in microscopic colitis. In particular, patients who are not budesonide-refractory may be more likely to respond.

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