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FAQs about Collagenous and Lymphocytic Colitis

What is collagenous colitis? How is lymphocytic colitis different from collagenous colitis?
Both collagenous colitis and lymphocytic colitis are forms of microscopic colitis characterized by inflammation in the large intestine. Both of these conditions usually present in middle age (fifties to sixties). Collagenous colitis occurs most often in women. Lymphocytic colitis is equally distributed between men and women, but appears just a bit earlier—usually early in the fifth decade of life. The main difference between the two is histological. In collagenous colitis, there is a thickened layer of collagen (a major protein in connective tissue, cartilage and bone) in the mucosal lining of the colon, whereas in lymphocytic colitis there is none. Because of the clinical and other similarities of these two disorders, they are commonly considered a single category of inflammatory bowel disease for the purposes of treatment.

What causes collagenous and lymphocytic colitis?
The cause of collagenous and lymphocytic colitis is unknown. Some theories include ingestion of non-steroidal anti-inflammatory drugs, regulation abnormalities of the immune system and the introduction of foreign bacterial organisms in the intestine.

Does collagenous colitis have a hereditary or genetic link?
Most patients diagnosed with microscopic colitis are Caucasians living in Northern Europe, Canada, the United States, Australia and New Zealand. Only a few patients have reported a close family member with the same diagnosis or with similar intestinal symptoms.

What are the symptoms of collagenous colitis?
Most patients with collagenous colitis present with chronic, watery, noninfectious diarrhea, cramps and abdominal pain.

How is it diagnosed?
Lower endoscopy with colonic biopsy is the method of diagnosis. Colonoscopy is the primary method for examining the colon. Colorectal biopsy can establish a definitive diagnosis of collagenous or lymphocytic colitis. The Westergren sedimentation rate and eosinophil count may be elevated, and there may be abnormalities in complement levels and serum immunoglobulins.

What is the incidence of collagenous colitis?
The incidence of this disorder is approximately 1.8 cases per 100,000 . In the presence of chronic diarrhea, the frequency of collagenous colitis ranges from 0.3 percent to 5 percent.

What is the treatment for collagenous colitis?
In most cases, collagenous and lymphocytic colitis respond to medical therapy. Anti-inflammatory agents, antibacterial agents, antidiarrheal medications, steroids, a low-fat diet and elimination of foods containing lactose and caffeine have all been reported to be effective in improving symptoms. Although these therapeutic approaches have demonstrated symptomatic improvement, there have been few patients with total histological reversal. Questions still remain regarding the duration of therapy and the utility of histological appearance as a treatment guide. Physicians should also consider the risk-benefit ratio when treating mildly symptomatic patients with corticosteroids.

Can collagenous colitis be cured?
Because experience is limited, the danger of leaving these disorders untreated is not known. It is unknown whether colonic inflammation of this type may predispose patients to future complications, such as abnormal cell growth or lesions. On one hand, spontaneous remission has been documented in some patients; exacerbation after discontinuation of anti-inflammatory medications has been noted in others. The appropriate duration of therapy is difficult to define.

Will I need an endoscopy, biopsies or other tests?
Colonoscopy is the primary method for examination of the colon, and biopsy of the lower gastrointestinal tract for the procurement of a sample of the colonic tissue for histological analysis. Blood tests and a stool sample may also be required to aid in diagnosis.

Can this disease cause cancer?
It is unknown at this time whether chronic inflammation of this type can lead to neoplasms. Experience with this disease is limited, but one study suggests there is no increased risk for colorectal cancer in this group of patients.

 

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