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Collagenous Colitis, Lymphocytic Colitis


Disease: Collagenous Colitis, Lymphocytic Colitis Collagenous Colitis, Lymphocytic Colitis
Category: Digestive diseases
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Disease Definition:

Collagenous colitis and lymphocytic colitis are inflammatory conditions of the colon that result in chronic, non-bloody, watery diarrhea. Some researchers consider collagenous colitis and lymphocytic colitis are different phases of the same condition rather than separate conditions.
Since the diagnosis of this condition is confirmed by microscopic examination, both collagenous colitis and lymphocytic colitis are occasionally referred to collectively as microscopic colitis. Collagenous colitis and lymphocytic colitis are more dominant in older adults. Moreover, it is less common in men than in women.
Treatment involves a phased approach, likely changing lifestyle. Fortunately, adjusting the diet will be enough to resolve the symptoms in many cases. However, if that was not enough, the doctor can recommend a number of effective medications for collagenous colitis and lymphocytic colitis. Surgery is hardly ever necessary.

Work Group:

Prepared by: Scientific Section

Symptoms, Causes


Collagenous colitis and lymphocytic colitis could affect different portions of the colon. The inflammation seems to be taking place in patches along the lining of the colon in some people, while in others it is present along the whole length of the bowel.
Collagenous colitis took its name from the thickened layer of connective tissue (collagen) in the colon’s lining. Lymphocytic colitis took its name from the increased level of specialized white blood cells (lymphocytes) found in the colon.
The signs and symptoms are virtually identical in both collagenous colitis and lymphocytic colitis. The most common sign is chronic diarrhea. This diarrhea is watery and non-bloody, and usually begins quite unexpectedly. The diarrhea might become constant, or in some people, it’s intermittent, with symptoms improving and then getting worse again in a repeated cycle. Most affected people might have from four to nine watery bowel movements a day, though with this condition up to 20 daily bowel movements are possible. Signs and symptoms usually appear for months preceding a proper diagnosing.

Signs and symptoms of collagenous colitis and lymphocytic colitis include:


  • Nausea
  • Chronic diarrhea
  • Dehydration
  • Fecal incontinence
  • Abdominal bloating (distention)
  • Abdominal pain or cramps
  • Modest weight loss

When having watery, non-bloody diarrhea lingering more than a few days, a doctor should be seen so that the condition could be diagnosed and properly treated.


It is not certain why collagenous colitis and lymphocytic colitis occur. Some researchers consider bacteria and toxins that they produce or a virus might trigger the inflammation linked to these conditions. Other investigators came up with theories which indicate that these disorders are autoimmune problems, meaning that the body’s own immune system is overactive and in fact attacks and damages healthy cells, mistakenly recognizing them as foreign invaders.Actually, people with collagenous colitis or lymphocytic colitis usually have one or more additional autoimmune disorders as well. Including the followings:


  • Diabetes mellitus
  • Thyroid disorders
  • Celiac disease, a digestive system disorder related to the intake of the protein gluten that might have the same signs and symptoms as microscopic colitis.
  • Pernicious anemia, a condition that causes low red blood cell counts
  • Rheumatoid arthritis
  • CREST syndrome, a connective tissue disorder affecting the skin and blood vessels
  • Scleroderma, a disease of the skin and connective tissue
  • Sjogren’s syndrome, an immune system dysfunction resulting in inflammation of the connective tissue

There have been some reports of collagenous colitis and lymphocytic colitis occurring in families, suggesting a possible genetic component in some cases.
The use of certain medication have been related to an increased risk of collagenous colitis and lymphocytic colitis in some people, but this relation is not proved yet. The implicated medications include non-steroidal anti-inflammatory medications (NSAIDs), like aspirin and ibuprofen (Advil, Motrin, others). Other medications that are related to higher risk of collagenous colitis and lymphocytic colitis include the proton pump inhibitor known as lansoprazole (Prevacid), the selective serotonin reuptake inhibitor named sertraline (Zoloft), the anti-platelet medication called ticlopidine (Ticlid), the H-2-receptor blocker named ranitidine (Zantac), and the type 2 diabetes drug known as acarbose (Precose).
The patient should tell their doctor about all the medications they’ve been taking, particularly the ones they’ve started taking in the months preceding the onset of their diarrhea.



Although other inflammatory diseases of the extended intestine like in the case of Crohn’s disease and ulcerative colitis raise the likelihood of growing cancer of the colon, but there’s no proof that either collagenous colitis or lymphocytic colitis raises the risk of colon cancer or death.


Collagenous colitis often improves without treatment and goes away within weeks. Yet, when the signs and symptoms are serious, doctors in general regard treatment as a necessity. The therapy is the same for both collagenous colitis and lymphocytic colitis. Doctors often recommend a stepwise approach, beginning with the simplest, most easily tolerated treatments aiming to produce the relief of symptoms.

  • Lifestyle changes. The patient will initially need to make adjustments to their diet. By reducing the quantity of fat they consume, which may help to ease their signs and symptoms. Additionally, caffeine should be removed from their diet (found in coffee, tea and soft drinks), as well as foods including lactose (milk sugar found in dairy products). spicy foods and alcohol should be avoided as well. It may also help to stay away from foods that might contribute to gas and diarrhea, including carbonated beverages, caffeine, raw fruits and vegetables like beans, cauliflower, broccoli and cabbage.

When taking over-the-counter non-steroidal anti-inflammatory medications, like aspirin, ibuprofen and naproxen (Aleve), doctor should be consulted about switching to other kinds of pain relievers. These NSAIDs could make the diarrhea worse related to collagenous colitis and lymphocytic colitis.


  • Medications. Taking medications might be considered, should problems persist despite adjustments in lifestyle. However, before the doctor recommends medications, they would want to exclude other possible causes for their symptoms, like celiac disease.

Doctors usually suggest beginning with antidiarrheal preparations like loperamide (lmodium) or the combination medication diphenoxylate and atropine (Lomotil) once the diagnosis is made. For many people, specifically those whose diarrhea is mild to moderate, they’re effective treatment, and they’re well tolerated in most cases. In case signs and symptoms do not subside with these medications, the doctor might recommend a different drug, like bismuth subsalicylate (Pepto-Bismol). The cholesterol-lowering medication cholestyramine (Questran) might be used. Cholestyramine helps treating lymphocytic colitis by absorbing bile acids that might be resulting in diarrhea. This drug is related to the side effect of bloating.

If these medications don’t relieve symptoms, the doctor might recommend a course of treatment with a corticosteroid medication like budesonide (Entocort). To decrease the risk of side effects, in general, this medication is taken for a maximum of two months. The corticosteroid known as prednisone might be used for more severe cases, but this medication is related to more side effects than budesonide. After finishing a course of treatment with either of these corticosteroid medications, there might be a chance of recurrence. Other medications that are used to decrease colon swelling and inflammation include anti-inflammatory medications like mesalamine (Asacol, Pentasa) and sulfasalazine (Azulfidine) and immunosuppressive medications like methotrexate (Rheumatrex) and azathioprine (Imuran).More studies are required to see the effectiveness of these medications in the management of collagenous colitis and lymphocytic colitis.


  • Surgery. In severe cases of collagenous colitis and lymphocytic colitis where medications aren’t effective, the doctor might recommend surgery to remove inflamed parts of their colon that seems to rule out diarrhea. Surgery is seldom regarded for these conditions.

In many people suffering from collagenous colitis or lymphocytic colitis, remaining symptoms could interfere with quality of life. But with suitable treatment, the prognosis for most people is good, and symptoms gradually resolve completely.


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