What is Lymphocytic Colitis?
Lymphocytic colitis is a rare gastrointestinal condition characterised by chronic non bloody/ watery diarrhoea due to inflammation of the colon or the large intestine. The term lymphocytic colitis was coined by Lazenby to differentiate the condition of other inflammatory bowel issues such as Crohn’s disease and ulcerative colitis. The term was possibly named due to increased number of lymphocytes in the affected tissue. The colon usually appears normal with flexible sigmoidoscopy or colonoscopy, but shows signs of inflammation under microscopic examination. Since the colonic mucosa is not disrupted or ulcerated, chances of blood stained or pus stained stool is rare.
Microscopic colitis is a term that is also used to describe lymphocytic colitis and another condition with similar signs and symptoms known as collagenous colitis. The symptoms, diagnostic testing and management of both these condition are same. Some believe lymphocytic colitis and collagenous colitis are part of the same condition but at different phases. The microscopic difference between lymphocytic colitis and collagenous colitis are mentioned below:
Lymphocytic Colitis: This is characterised by increased number of white blood cells (WBCs) or lymphocytes in the colon tissue.
Collagenous Colitis: This is characterised by presence of a thick layer of collagen (a protein) in the colon tissue.
Symptoms of Lymphocytic Colitis
Lymphocytic colitis is often suspected upon observing persistent unexplained diarrhoea without any blood or pus discharge. The colon appears normal upon radiographic or endoscopic examination. The symptoms associated with this condition include:
- Chronic watery stool discharge
- Faecal incontinence
- Abdominal discomfort with tenderness and cramps
- Unintentional weight loss
- Nausea and generalized weakness.
Causes of Lymphocytic Colitis
Lymphocytic colitis is a rare condition and the exact cause of the condition is yet unknown. Researches are being carried out to know more about this condition and figure out the cause of this unique condition. However, based on observation, researchers believe the possible causes of Lymphocytic colitis are as mentioned below:
Side Effects of Medications: Excessive intake of certain medications can cause irritation in the lining of the colon leading to inflammation.
Bacterial or Viral Infections: Certain bacteria have the ability to produce toxins which may irritate the mucosal lining. Some viruses can also initiate inflammation.
Presence of other Auto Immune Conditions: Auto immune condition is defined as a medical condition where the body’s immune system attacks the normal healthy tissues of the body. Lymphocytic colitis has been seen is close association with auto immune conditions such as celiac disease or rheumatoid arthritis.
Reaction to Bile Acid: Bile acid if not absorbed by the body, it may irritate the colon lining.
Risk Factors with Lymphocytic Colitis
The risk factors associated with lymphocytic colitis include:
Age and Gender of the Individual: It has been noted that lymphocytic colitis is common between the age group of 50 to 70 years. It affects women more than men. This is possibly due to hormonal changes in women post menopause.
Presence of Auto Immune Diseases: Lymphocytic colitis is often associated with other underlying auto immune conditions such as rheumatoid arthritis, psoriasis, celiac disease, thyroid disease, type 1 diabetes etc.
Genetic Inheritance as a Risk Factor for Lymphocytic Colitis: The chances of acquiring lymphocytic colitis are more among people who has a family history of gastro-intestinal issues such as irritable bowel syndrome (IBS).
Smoking: Studies have shown that there is a link between smokers and developing lymphocytic colitis. This is more evident among individuals with history of smoking between the ages of 16 and 44 years.
Medications: As mentioned earlier, intake of certain medications have adverse effect on the mucosa of the colon. These medications include:
- Proton pump inhibitors such as Prevacid, Nexium, Protonix, Prilosec etc.
- Analgesics such as aspirin, acetaminophen, ibuprofen etc.
- Other drugs such as Flutamide, Ranitidine, Acarbose, Clozapine, Paroxetine, Simvastatin, Entacapone etc.
- SSRIs or selective serotonin reuptake inhibitors such as Zoloft and sertraline.
Diagnosis of Lymphocytic Colitis
The symptoms are often mistaken as other abdominal issues. If the symptoms do not improve within a few days, it is advised to consult a specialist for management of the condition. The condition is treated by a gastroenterologist. A detailed case history is obtained followed by physical examination. Special attention is given to note down history of medications, which may increase the chance of developing lymphocytic colitis. A few tests are done to rule out other conditions such as celiac disease. Specific tests include biopsy of the colon tissue, which is obtained during colonoscopy or sigmoidoscopy. These tests are done by inserting a long thin tube into the colon through the rectal opening. The thin tube has a camera on its end to examine the inner portion of the colon; and a tissue sampling device, to collect tissue material for biopsy. Other tests include stool sample analysis and blood work, to look for secondary infection and anaemia. Upper abdomen endoscopy with biopsy may be done to rule out celiac disease.
Treatment and Management of Lymphocytic Colitis
In some cases, lymphocytic colitis may improve on its own. However, in advanced cases, treatment may be necessary. The most common treatment modality includes:
Dietary Modification to Treat Lymphocytic Colitis: Patients affected by this condition are advised to follow a low fat, low fibre diet. It is recommended to avoid dairy and gluten products and limit caffeine intake. Sugar intake should be reduced.
Lifestyle Modification to Manage Lymphocytic Colitis: Simple changes in lifestyle such as adequate hydration, avoiding irritable food, including more of easily digestible food in diet, eating smaller and frequent meals can help in controlling the condition.
Medications: In some cases, the physician may prescribe medications to control the symptoms. These include anti diarrheal medications, medications that block production of bile acids, anti-inflammatory drugs, medications for supressing immune system etc.
Discontinuation of medications that are suspected to increase the irritation.
Surgical Intervention for Lymphocytic Colitis: In extreme cases, if the condition does not improve with dietary modifications, lifestyle modification or introduction of new medications, surgery may be recommended to treat the condition.
Prognosis and Complications of Lymphocytic Colitis
The prognosis of lymphocytic colitis once diagnosed is good. Most of the individuals are successfully treated without further complications.
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