Collagenous colitis, and the related condition lymphocytic colitis, are relatively common causes of watery diarrhoea, particularly in the elderly. Epidemiological studies suggest that the incidence of these conditions is increasing significantly.1 Despite these facts, there have been relatively few randomised controlled trials assessing treatment options. Budesonide has been assessed in at least three randomised, controlled induction studies in collagenous colitis2 and one in lymphocytic colitis,3 and is superior to placebo for the short-term treatment of these conditions. Unfortunately, although budesonide appears to be very effective for induction, the relapse rate is high once this medication is discontinued.4

Therefore, it is appropriate for clinicians and patients to ask, after budesonide, what next for collagenous colitis? There have now been two studies assessing budesonide maintenance therapy in collagenous colitis in a randomised, placebo controlled fashion. The first, by Bonderup and colleagues, appears in this issue of Gut (see page 68).5 In this well done study, 34 patients in remission after 6 weeks open-label therapy with oral budesonide were randomised to 24 weeks additional therapy with budesonide, 6 mg/day, or placebo. Patients were then followed for an additional 24 weeks after discontinuation of therapy to assess the durability of response to prolonged budesonide treatment.

After the 6 week open-label induction period, approximately 87% of patients were …