Lymphocytic colitis is a condition affecting the large intestine, leading to chronic inflammation. This inflammation results in persistent watery diarrhea and can impact daily life. While the exact cause remains under investigation, it is classified as a type of inflammatory bowel disease (IBD).
Understanding Lymphocytic Colitis
Lymphocytic colitis is a form of microscopic colitis, a term used for inflammatory conditions of the colon that are only identifiable when tissue samples are examined under a microscope. Unlike other inflammatory bowel diseases such as Crohn’s disease or ulcerative colitis, the colon’s appearance often looks normal during a colonoscopy. The distinguishing feature of lymphocytic colitis is an increased number of white blood cells called lymphocytes within the lining of the colon. Microscopic colitis also includes collagenous colitis, which shares similar symptoms but is characterized by a thickened layer of collagen in the colon lining.
Recognizing the Symptoms
The primary symptom experienced by individuals with lymphocytic colitis is chronic, watery diarrhea that typically does not contain blood. This diarrhea can be frequent. The persistent nature of the diarrhea can lead to dehydration, fatigue, and unintended weight loss.
Abdominal pain or cramping is another common symptom, affecting about half of those with the condition. Bloating, nausea, and a feeling of urgency to have a bowel movement can also occur. For some, symptoms might come and go, with periods of improvement followed by flare-ups. Some individuals may experience other inflammatory signs, such as joint pain or skin rashes.
Identifying the Causes
The precise cause of lymphocytic colitis is not yet fully understood, but several factors are thought to contribute to its development. Theories include an overactive immune response, suggesting an autoimmune component where the body’s immune system mistakenly attacks healthy colon cells. Many individuals with lymphocytic colitis also have other autoimmune disorders, such as celiac disease or thyroid conditions.
Certain medications have been linked to an increased risk of developing lymphocytic colitis. These include non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, proton pump inhibitors (PPIs) used for acid reflux, and selective serotonin reuptake inhibitors (SSRIs) which are antidepressants. Infections, whether bacterial or viral, are also considered potential triggers. The condition most commonly affects middle-aged and older adults, particularly women, and smoking may increase the risk and lead to earlier onset.
Diagnosis Methods
Diagnosing lymphocytic colitis relies on a combination of clinical evaluation and microscopic examination of colon tissue. Since the colon often appears normal during a standard colonoscopy, a biopsy of the colon lining is essential for confirmation. During a colonoscopy, a gastroenterologist will collect multiple small tissue samples from different areas of the colon. These samples are then sent to a pathology lab for detailed analysis under a microscope.
Pathologists look for specific changes, primarily an abnormal increase in lymphocytes within the surface lining of the colon. In lymphocytic colitis, the subepithelial collagen layer, which is thickened in collagenous colitis, typically remains normal or only slightly thicker. The diagnosis also involves ruling out other conditions that cause similar symptoms, such as infections or other forms of inflammatory bowel disease, often through blood tests and stool analyses.
Treatment Approaches
Managing lymphocytic colitis often begins with lifestyle adjustments and medications aimed at controlling symptoms and reducing inflammation. Dietary modifications can be helpful, as certain foods and drinks like caffeine, alcohol, artificial sweeteners, and high-fat or high-fiber items might worsen diarrhea for some individuals. Identifying and avoiding personal triggers can significantly alleviate symptoms.
Anti-diarrheal medications, such as loperamide, are often used to help manage the frequent watery stools. For many, the corticosteroid budesonide is a first-line medical treatment due to its localized action in the colon and fewer systemic side effects compared to other steroids. Budesonide works to reduce the inflammation in the colon and has shown effectiveness in inducing remission. If budesonide is not effective or well-tolerated, other medications like bismuth subsalicylate or other anti-inflammatory drugs may be considered. In some persistent cases, other immunosuppressants or biologic therapies typically used for other inflammatory bowel diseases might be explored.