Lymphocytic Colitis

Lymphocytic colitis is a type of microscopic colitis, an inflammation of the large intestine (colon) that is not visible during a standard colonoscopy. Instead, it is diagnosed by examining tiny tissue samples (biopsies) under a microscope, which show an increased number of white blood cells called lymphocytes in the colon lining. This condition primarily causes chronic watery diarrhea and abdominal pain.

What is Lymphocytic Colitis?

Lymphocytic colitis is a condition where the lining of your large intestine (colon) becomes inflamed. It is a type of microscopic colitis, meaning the inflammation is only visible when tissue samples (biopsies) are examined under a microscope, not during a regular colonoscopy. The microscopic view shows an increased number of specific white blood cells called lymphocytes in the colon lining.

Lymphocytic colitis is one of two main types of microscopic colitis, the other being collagenous colitis. Both conditions share similar symptoms and are diagnosed in the same way. The key difference lies in the specific changes seen in the colon tissue under a microscope. This inflammation causes the colon to absorb less water, leading to its main symptom: chronic watery diarrhea. While the exact cause is often unknown, it is not considered an autoimmune disease itself, but it is often linked to other autoimmune conditions. It is also not related to inflammatory bowel diseases like Crohn's disease or ulcerative colitis, nor does it increase your risk of colon cancer.

Symptoms

The main symptoms of lymphocytic colitis are chronic watery diarrhea and abdominal pain or cramping. These symptoms can come and go, often lasting for weeks or months at a time. Other less common symptoms can include nausea, dehydration due to fluid loss, and sometimes unintentional weight loss.

People with lymphocytic colitis typically experience persistent watery diarrhea, which can occur multiple times a day. This diarrhea is usually not bloody. Abdominal pain, often described as cramping, is also a common complaint and can range from mild to severe. Less frequently, individuals may also experience nausea, which can contribute to a general feeling of unwellness. Due to the frequent diarrhea, dehydration can become a concern if fluid intake does not keep up with fluid loss. In some cases, significant diarrhea and discomfort can lead to a decrease in appetite and unintentional weight loss. It is important to discuss any of these symptoms with your doctor.

Causes & risk factors

The exact cause of lymphocytic colitis is often unknown, but it is believed to involve a combination of factors, including immune system responses and certain medications. Risk factors include being an older adult, being female, having other autoimmune diseases, and using specific types of drugs.

While the precise cause remains unclear, researchers believe that lymphocytic colitis may be triggered by an abnormal immune response in the colon. This response leads to the increased number of lymphocytes seen in the colon lining. It is not directly caused by an infection. Several factors can increase your risk of developing lymphocytic colitis. It is more common in older adults, typically affecting people over age 50, and occurs more frequently in women than in men. There is also a strong link to other autoimmune diseases, such as celiac disease, thyroid disease, rheumatoid arthritis, and type 1 diabetes. Certain medications are also known risk factors. These include nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, proton pump inhibitors (PPIs) used for acid reflux, selective serotonin reuptake inhibitors (SSRIs) for depression, statins for high cholesterol, and some other drugs like ranitidine, carbamazepine, and flutamide. If you are taking any of these medications and experience symptoms, your doctor may consider if they are contributing to your condition.

How it's diagnosed

Lymphocytic colitis is diagnosed through a colonoscopy with biopsies, as the colon often appears normal to the naked eye. During this procedure, a doctor uses a flexible tube with a camera to examine the colon and takes tiny tissue samples. These samples are then examined under a microscope to confirm the presence of increased lymphocytes.

Because the inflammation of lymphocytic colitis is microscopic, a standard colonoscopy alone cannot diagnose the condition. During a colonoscopy, your doctor will insert a thin, flexible tube with a light and camera into your rectum to view the inside of your colon. Even if the colon lining looks healthy, biopsies (small tissue samples) must be taken. These tiny tissue samples are then sent to a pathology lab. A pathologist, a doctor who specializes in examining tissues, will look at the samples under a microscope. The diagnosis of lymphocytic colitis is confirmed when the pathologist observes an abnormally high number of lymphocytes within the colon lining, along with other characteristic changes. Before the colonoscopy, your doctor will likely review your medical history, including any medications you are taking, and perform a physical exam. Blood tests or stool tests may also be done to rule out other conditions that cause similar symptoms, such as infections or celiac disease.

Treatment options

Treatment for lymphocytic colitis often begins by identifying and stopping any medications that might be contributing to the condition. Over-the-counter anti-diarrhea medicines can help manage symptoms. The most effective prescription treatment is typically budesonide, a steroid that works mainly in the gut.

The first step in treating lymphocytic colitis is often to review all your current medications with your doctor. If a medication is suspected to be causing or worsening your symptoms, your doctor may advise you to stop taking it or switch to an alternative, if possible. Never stop taking prescribed medication without consulting your doctor. For symptom relief, over-the-counter anti-diarrhea medications, such as loperamide, can help reduce the frequency of watery stools. Bismuth subsalicylate is another over-the-counter option that may help induce remission in some people. Your doctor can guide you on appropriate use. The most commonly prescribed and effective medication for inducing and maintaining remission in lymphocytic colitis is budesonide. This is a type of corticosteroid that works primarily in the gut, meaning it has fewer side effects throughout the body compared to other steroids like prednisone. For severe or persistent cases that do not respond to budesonide, your doctor might consider other medications, such as mesalamine (though its effectiveness is less clear) or immunomodulators like azathioprine or methotrexate, which suppress the immune system. Dietary changes, such as avoiding caffeine, lactose, gluten, or artificial sweeteners, are sometimes suggested, but there is limited strong evidence to support their effectiveness for everyone.

Recovery & outlook

Lymphocytic colitis is often a chronic condition, meaning it can last a long time, but it is generally not life-threatening and does not increase your risk of colon cancer. Many people experience periods of remission, where symptoms improve or disappear, followed by flare-ups. With appropriate treatment, symptoms can often be managed effectively.

The course of lymphocytic colitis can vary greatly from person to person. Some individuals may experience a single episode of symptoms that resolves with treatment and does not return. For others, it can be a chronic condition with periods of remission, where symptoms are absent or mild, and periods of flare-ups, where symptoms return or worsen. It is important to understand that lymphocytic colitis is a benign condition. It does not lead to more serious diseases like inflammatory bowel disease (Crohn's disease or ulcerative colitis) and does not increase your risk of developing colon cancer. This can be reassuring for many people who are concerned about their diagnosis. With proper diagnosis and treatment, most people with lymphocytic colitis can achieve good symptom control and a good quality of life. Regular follow-up with your doctor is important to monitor your condition, adjust treatments as needed, and manage any potential side effects of medications.

When to see a doctor

You should see a doctor if you experience persistent watery diarrhea, especially if it lasts for more than a few days, or if you have severe abdominal pain. Seek immediate medical attention if you develop signs of dehydration, such as excessive thirst, infrequent urination, or dizziness, or if you notice blood in your stool.

It is important to consult your doctor if you have ongoing watery diarrhea that does not improve with over-the-counter remedies or lasts for several days or weeks. Also, seek medical advice if you experience frequent or severe abdominal pain or cramping. Certain symptoms warrant more urgent medical attention. If you develop signs of dehydration, such as feeling very thirsty, having dry mouth, urinating less often, feeling lightheaded or dizzy, or experiencing extreme fatigue, you should contact your doctor right away or seek emergency care. Dehydration can be serious if not addressed promptly. Although lymphocytic colitis typically does not cause bloody diarrhea, any blood in your stool should always be evaluated by a doctor to rule out other potential causes. If you have any new or worsening symptoms, or if your current treatment is not effectively managing your condition, it is crucial to speak with your healthcare provider.

Frequently asked questions

Is lymphocytic colitis an autoimmune disease?

Lymphocytic colitis is not classified as an autoimmune disease itself, but it is often linked to other autoimmune conditions like celiac disease or thyroid disease. The exact cause is unknown, but it may involve an abnormal immune response in the colon.

Can diet help manage lymphocytic colitis?

While there is limited strong scientific evidence, some people find that avoiding certain foods like caffeine, lactose, gluten, or artificial sweeteners may help reduce their symptoms. It's best to discuss any dietary changes with your doctor or a dietitian.

Is lymphocytic colitis the same as IBS?

No, lymphocytic colitis is not the same as irritable bowel syndrome (IBS). While both can cause chronic diarrhea and abdominal pain, lymphocytic colitis involves actual inflammation visible under a microscope, whereas IBS does not show any visible inflammation or tissue changes.

Will lymphocytic colitis increase my risk of colon cancer?

No, lymphocytic colitis is considered a benign condition and does not increase your risk of developing colon cancer. This is an important distinction from other inflammatory bowel diseases like ulcerative colitis.

How long does a flare-up of lymphocytic colitis typically last?

The duration of a flare-up can vary greatly among individuals. Some flare-ups may last for a few days or weeks, while others can persist for months. With effective treatment, symptoms can often be brought under control more quickly.

Are there any long-term complications of lymphocytic colitis?

Lymphocytic colitis itself is not associated with severe long-term complications or increased mortality. The main long-term concern is the chronic nature of symptoms, which can impact quality of life if not properly managed. Dehydration can be a complication if diarrhea is severe and prolonged.

Sources

• MedlinePlus — Lymphocytic Colitis
• Mayo Clinic — Lymphocytic Colitis
• Cochrane Library — Lymphocytic Colitis