Collagenous and Lymphocytic (Microscopic) Colitis – Symptoms, Treatment
Colitis refers to inflammation of the colon (the main part of the large intestine) that usually causes abdominal pain and diarrhea.
Collagenous and Lymphocytic Colitis
Old people between 60-80 years of age may suffer from two special types of colitis. One type is collagenous colitis with excessive amount of connective tissue (collagen) in the mucosal layer of the colon. In the another type – lymphocytic colitis – lymphocytes ( a special type ow white cells) can be found in colonic mucosa. Some researchers believe that both types represent two different phases of the same disorder.
Main symptoms in both types are watery diarrhea (without blood) and left or right side abdominal pain.
Diagnosis can be made only with examination of a sample of colonic mucosa under the microscope, obtained during colonoscopy. This is why a term microscopic colitis is used for both types of colitis.
Causes and Risk Factors
Exact cause of microscopic colitis is not known.
Microscopic colitis has been considered as an autoimmune disease, since other autoimmune diseases like celiac disease, diabetes, systemic sclerosis, rheumatoid arthritis, pernicious anemia (with low vitamin B12), Syögren syndrome and CREST syndrome are often found in patients with microscopic colitis (2).
Some acid-lowering drugs like Prevacid or Zoloft were connected with microscopic colitis.
Treatment of Microscopic Colitis
Mild microscopic colitis may resolve on its own in few weeks without any treatment.
Antiinflamatory drugs like sulfasalazine may reduce inflammation and should be tried first (1). If this doesn’t help, a corticosteroid budesonide (Entocort) should be tried (1). Prednisone has many side effects and should be avoided. Aspirin, ibuprofen and other non-steroid anti-inflammatory drugs should be also avoided, since they themselves may cause microscopic colitis (1).
Antidiarrheal drugs like Lomotil or Imodium, when taken with small amount of water, may absorb excessive water in the colon and thus prevent diarrhea (1).
Cholestyramine (cholesterol lowering drug) binds bile acids in the small intestine thus preventing them to reach the colon and irritate it (1).
Diet. Avoiding fat, milk, fibers, spices, alcohol and caffeine may reduce diarrhea. No other special diet is needed. Enough fluid should be drunk to prevent dehydration (1).
Prognosis
In most cases, microscopic colitis resolves completely within weeks. In some patients colitis may reoccur, but it rarely cause severe complications.
References:
- Lymphocytic colitis (emedicine.medscape.com)
- Microscopic colitis (mayoclinic.com)
