Lymphocytic Colitis (LC) is a condition affecting the large intestine that falls under the umbrella of microscopic colitis. This classification indicates that the inflammation causing symptoms is not visible during a standard colonoscopy but can only be detected when tissue samples are examined under a microscope. The underlying issue involves chronic inflammation of the colon’s lining.
What Lymphocytic Colitis Is
Lymphocytic Colitis is defined by a specific change in the colon tissue where a high concentration of inflammatory white blood cells, called lymphocytes, infiltrate the lining. This microscopic inflammation interferes with the colon’s ability to reabsorb water properly, leading directly to the primary symptom.
The most common symptom is chronic, watery, non-bloody diarrhea, which can occur multiple times a day and often wakes individuals from sleep. Patients frequently report abdominal pain, cramping, and significant fatigue, sometimes accompanied by weight loss. A diagnosis of LC requires a specialized biopsy taken during a colonoscopy, confirming the presence of the inflammatory infiltrate.
LC is seen more often in older adults, with the median age of diagnosis typically falling around 60 to 65 years. Women are approximately twice as likely to develop the condition compared to men.
Research suggests that various factors may trigger the onset, including the use of certain medications like nonsteroidal anti-inflammatory drugs (NSAIDs) and proton pump inhibitors (PPIs). Additionally, there is a recognized association between LC and other autoimmune diseases, such as Celiac disease and thyroid disorders, suggesting a possible immune system component.
Understanding the LongTerm Outlook
Lymphocytic Colitis is generally considered a benign condition that does not shorten a person’s lifespan. The inflammation remains confined to the inner lining of the colon and does not progress to involve deeper layers of the bowel wall. This is a significant distinction from other forms of inflammatory bowel disease (IBD), such as Crohn’s disease or Ulcerative Colitis, which can lead to severe structural damage.
Crucially, LC is not associated with an increased risk of developing colorectal cancer. This is true regardless of how long a person has the condition or how many times symptoms reappear.
The severity of LC primarily relates to its impact on an individual’s quality of life due to the relentless nature of the diarrhea. Episodes can be chronic and relapsing, meaning symptoms may resolve with treatment only to return months or years later.
While the condition itself is not life-threatening, the persistent, watery bowel movements can cause significant distress, social isolation, and potential complications like dehydration or electrolyte imbalance if left unmanaged. Many patients experience either spontaneous remission or achieve long-term remission with appropriate treatment. The disease does not typically cause permanent or irreversible damage to the gastrointestinal tract.
Current Treatment Approaches
The management of Lymphocytic Colitis follows a stepwise approach, beginning with the identification and removal of any potential triggers. Patients are often advised to discontinue non-essential medications, such as NSAIDs, that have been linked to symptom exacerbation.
Making simple dietary changes, such as limiting caffeine, dairy products, or high-fiber foods that can worsen diarrhea, is a foundational part of initial therapy.
For most patients, the first-line pharmacological treatment is a specialized corticosteroid called budesonide. This medication is designed to act locally within the gut, minimizing the absorption of the steroid into the bloodstream and reducing systemic side effects.
A standard treatment course involves a dose of 9 milligrams daily for about six to eight weeks to induce clinical remission. Budesonide is highly effective, with clinical response rates reported in over 80% of patients, often leading to the complete resolution of diarrhea.
If symptoms are mild, or if budesonide is not tolerated, anti-diarrheal agents like loperamide or bile acid binders may be used for symptom control. For individuals whose condition is refractory or who frequently relapse, second-line treatments include immunosuppressants or, in rare cases, biologic therapies.