@barb1954 from the American Journal of Gastroenterology - VOLUME 120 | SUPPLEMENT | OCTOBER 2025 -
I don't understand all of this, but it sounds like something that has been tried with success to replace Budesonide -

S4994
JAK of All Trades: Upadacitinib-Induced Remission of Medically Refractory Lymphocytic Colitis
Kevin R. O’Connor, MD*, Ryan A. McConnell, MD, Anna Thiemann, MD
Introduction: Microscopic colitis (MC) is an idiopathic, inflammatory colitis that causes chronic
watery diarrhea and adversely impacts quality of life. Remission is defined clinically with the
Hjortswang criteria (mean of ,3 stools/day and ,1 watery stool/day). Most patients respond to
budesonide therapy, although relapse rates are high. Approximately 20% of patients have steroid-
refractory disease. Guidelines recommend thiopurines, anti-tumor necrosis factor agents, and
vedolizumab for budesonide-refractory MC. There is a paucity of data supporting these off-label
advanced therapies, particularly for newer agents, such as the Janus-Kinase (JAK) inhibitors. Here, we
present a case of upadacitinib-induced clinical remission of steroid-refractory lymphocytic colitis
(LC) in a patient with concurrent celiac disease.