Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Collagenous and Lymphocytic Colitis Clinical Presentation

  • Author: Joyann A Kroser, MD, FACP, FACG, AGAF; Chief Editor: BS Anand, MD  more...
 
Updated: Nov 02, 2015
 

History

A protracted course of nonbloody diarrhea occurs. Diarrhea may be of high volume; some patients may eliminate more than 1500 mL of fluid per day.

Symptoms may have been present from several months to 2-3 years before medical attention is sought and a diagnosis is made. In fact, perhaps half of patients proven to have microscopic colitis meet the Rome, Rome II, and Manning symptom-based criteria for diarrhea-predominant irritable bowel syndrome and may be so misdiagnosed until endoscopic biopsies of the colon are taken.

Less frequent complaints include abdominal cramping, fecal incontinence, and weight loss, although weight loss may be seen in 40% or more of patients with CC.

Incontinence is probably more a reflection of the advanced age of those individuals who are affected, and patients with this problem may do well if treated with antidiarrheal agents.

Next

Physical

Physical examination usually does not reveal any specific abnormalities. Severely affected individuals may show signs of dehydration, malnutrition, and weight loss.

Previous
 
 
Contributor Information and Disclosures
Author

Joyann A Kroser, MD, FACP, FACG, AGAF Adjunct Clinical Associate Professor of Medicine, Gastroenterology, and Hepatology, Drexel University College of Medicine; Adjunct Professor of Medicine, Temple University School of Medicine

Joyann A Kroser, MD, FACP, FACG, AGAF is a member of the following medical societies: American College of Physicians, Alpha Omega Alpha, Crohn's and Colitis Foundation of America, American College of Gastroenterology, American Gastroenterological Association, American Medical Association, American Society for Gastrointestinal Endoscopy, Pennsylvania Medical Society, Phi Beta Kappa, Philadelphia County Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Amandeep Singh, MBBS Resident Physician, Department of Internal Medicine, Crozer Chester Medical Center

Amandeep Singh, MBBS is a member of the following medical societies: American Academy of Family Physicians, American College of Gastroenterology, American College of Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Acknowledgements

Arun Chaudhary, MD Consulting Staff, Department of Internal Medicine, Wentworth-Douglass Hospital

Disclosure: Nothing to disclose.

Eric Goosenberg, MD Assistant Professor of Medicine, Temple University School of Medicine

Eric Goosenberg, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, and Bockus International Society of Gastroenterology

Disclosure: Nothing to disclose.

Douglas M Heuman, MD, FACP, FACG, AGAF Chief of GI, Hepatology, and Nutrition at North Shore University Hospital/Long Island Jewish Medical Center; Professor, Department of Medicine, Hofstra North Shore-LIJ School of Medicine

Douglas M Heuman, MD, FACP, FACG, AGAF is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Physicians, and American Gastroenterological Association

Disclosure: Novartis Grant/research funds Other; Bayer Grant/research funds Other; Otsuka Grant/research funds None; Bristol Myers Squibb Grant/research funds Other; Scynexis None None; Salix Grant/research funds Other; MannKind Other

References
  1. Jauregui-Amezaga A, Vermeire S, Geboes K. Contemporary methods for the diagnosis and treatment of microscopic colitis. Expert Rev Gastroenterol Hepatol. 2015 Oct 15. 1-15. [Medline].

  2. Freeman HJ, Weinstein WM, Shnitka TK, et al. Watery diarrhea syndrome associated with a lesion of the colonic basement membrane (CD)-lamina propria (LP) interface. Ann R Coll Phys Surg Can. 1976. 9:45.

  3. Mahajan D, Goldblum JR, Xiao SY, Shen B, Liu X. Lymphocytic colitis and collagenous colitis: a review of clinicopathologic features and immunologic abnormalities. Adv Anat Pathol. 2012 Jan. 19(1):28-38. [Medline].

  4. Bjornbak C, Engel PJ, Nielsen PL, Munck LK. Microscopic colitis: clinical findings, topography and persistence of histopathological subgroups. Aliment Pharmacol Ther. 2011 Nov. 34(10):1225-34. [Medline].

  5. Villanueva MS, Alimi Y. Microscopic colitis (lymphocytic and collagenous), eosinophilic colitis, and celiac disease. Clin Colon Rectal Surg. 2015 Jun. 28 (2):118-26. [Medline].

  6. Yen EF, Pokhrel B, Du H, Nwe S, Bianchi L, Witt B, et al. Current and past cigarette smoking significantly increase risk for microscopic colitis. Inflamm Bowel Dis. 2011 Dec 6. [Medline].

  7. Kandemir O, Utas C, Gonen O, et al. Colonic subepithelial collagenous thickening in diabetic patients. Dis Colon Rectum. 1995 Oct. 38(10):1097-100. [Medline].

  8. Christ AD, Meier R, Bauerfeind P, Wegmann W, Gyr K. [Simultaneous occurrence of lymphocytic gastritis and lymphocytic colitis with transition to collagenous colitis] [German]. Schweiz Med Wochenschr. 1993 Jul 31. 123(30):1487-90. [Medline].

  9. O'Mahony S, Nawroz IM, Ferguson A. Coeliac disease and collagenous colitis. Postgrad Med J. 1990 Mar. 66(773):238-41. [Medline]. [Full Text].

  10. Freeman HJ. Collagenous colitis as the presenting feature of biopsy-defined celiac disease. J Clin Gastroenterol. 2004 Sep. 38(8):664-8. [Medline].

  11. Kingsmore SF, Kingsmore DB, Hall BD, Wilson JA, Gottfried MR, Allen NB. Cooccurrence of collagenous colitis with seronegative spondyloarthropathy: report of a case and literature review. J Rheumatol. 1993 Dec. 20(12):2153-7. [Medline].

  12. Lettesjo H, Hansson T, Peterson C, et al. Detection of inflammatory markers in stools from patients with irritable bowel syndrome and collagenous colitis. Scand J Gastroenterol. 2006 Jan. 41(1):54-9. [Medline].

  13. Gunaltay S, Kumawat AK, Nyhlin N, et al. Enhanced levels of chemokines and their receptors in the colon of microscopic colitis patients indicate mixed immune cell recruitment. Mediators Inflamm. 2015. 2015:132458. [Medline].

  14. Miehlke S, Madisch A, Karimi D, et al. Budesonide is effective in treating lymphocytic colitis: a randomized double-blind placebo-controlled study. Gastroenterology. 2009 Jun. 136(7):2092-100. [Medline].

  15. Baert F, Wouters K, D'Haens G, Hoang P, Naegels S, D'Heygere F, et al. Lymphocytic colitis: a distinct clinical entity? A clinicopathological confrontation of lymphocytic and collagenous colitis. Gut. 1999 Sep. 45(3):375-81. [Medline].

  16. Baum CA, Bhatia P, Miner PB Jr. Increased colonic mucosal mast cells associated with severe watery diarrhea and microscopic colitis. Dig Dis Sci. 1989 Sep. 34(9):1462-5. [Medline].

  17. Bo-Linn GW, Vendrell DD, Lee E, Fordtran JS. An evaluation of the significance of microscopic colitis in patients with chronic diarrhea. J Clin Invest. 1985 May. 75(5):1559-69. [Medline].

  18. Burgel N, Bojarski C, Mankertz J, Zeitz M, Fromm M, Schulzke JD. Mechanisms of diarrhea in collagenous colitis. Gastroenterology. 2002 Aug. 123(2):433-43. [Medline].

  19. Cappell MS. Colonic toxicity of administered drugs and chemicals. Am J Gastroenterol. May 2004. 99(6):1175-90. [Medline].

  20. Chande N, MacDonald JK, McDonald JW. Interventions for treating microscopic colitis: a Cochrane Inflammatory Bowel Disease and Functional Bowel Disorders Review Group systematic review of randomized trials. Am J Gastroenterol. 2009 Jan. 104(1):235-41; quiz 234, 242. [Medline].

  21. Chande N, McDonald JW, Macdonald JK. Interventions for treating collagenous colitis: a Cochrane Inflammatory Bowel Disease Group systematic review of randomized trials. Am J Gastroenterol. 2004 Dec. 99(12):2459-65. [Medline].

  22. Fernandez-Banares F, Esteve M, Espinos JC, Rosinach M, Forne M, Salas A, et al. Drug consumption and the risk of microscopic colitis. Am J Gastroenterol. 2007 Feb. 102(2):324-30. [Medline].

  23. Fernandez-Banares F, Salas A, Esteve M, Espinos J, Forne M, Viver JM. Collagenous and lymphocytic colitis. evaluation of clinical and histological features, response to treatment, and long-term follow-up. Am J Gastroenterol. 2003 Feb. 98(2):340-7. [Medline].

  24. Fernandez-Banares F, Salas A, Forne M, Esteve M, Espinos J, Viver JM. Incidence of collagenous and lymphocytic colitis: a 5-year population-based study. Am J Gastroenterol. 1999 Feb. 94(2):418-23. [Medline].

  25. Freeman HJ. Collagenous mucosal inflammatory diseases of the gastrointestinal tract. Gastroenterology. 2005 Jul. 129(1):338-50. [Medline].

  26. Giardiello FM, Lazenby AJ. The atypical colitides. Gastroenterol Clin North Am. 1999 Jun. 28(2):479-90, x. [Medline].

  27. Giardiello FM, Lazenby AJ, Bayless TM. The new colitides, Collagenous, lymphocytic, and diversion colitis. Gastroenterol Clin North Am. 1995 Sep. 24(3):717-29. [Medline].

  28. Giardiello FM, Lazenby AJ, Yardley JH, Bias WB, Johnson J, Alianiello RG, et al. Increased HLA A1 and diminished HLA A3 in lymphocytic colitis compared to controls and patients with collagenous colitis. Dig Dis Sci. 1992 Apr. 37(4):496-9. [Medline].

  29. Limsui D, Pardi DS, Camilleri M, Loftus EV Jr, Kammer PP, Tremaine WJ, et al. Symptomatic overlap between irritable bowel syndrome and microscopic colitis. Inflamm Bowel Dis. 2007 Feb. 13(2):175-81. [Medline].

  30. Marshall JB, Singh R, Diaz-Arias AA. Chronic, unexplained diarrhea: are biopsies necessary if colonoscopy is normal?. Am J Gastroenterol. 1995 Mar. 90(3):372-6. [Medline].

  31. Maxson CJ, Klein HD, Rubin W. Atypical forms of inflammatory bowel disease. Med Clin North Am. 1994 Nov. 78(6):1259-73. [Medline].

  32. Miehlke S, Madisch A, Bethke B, Morgner A, Kuhlisch E, Henker C, et al. Oral budesonide for maintenance treatment of collagenous colitis: a randomized, double-blind, placebo-controlled trial. Gastroenterology. 2008 Nov. 135(5):1510-6. [Medline].

  33. Miehlke S, Madisch A, Karimi D, Wonschik S, Kuhlisch E, Beckmann R. Budesonide is effective in treating lymphocytic colitis: a randomized double-blind placebo-controlled study. Gastroenterology. 2009 Jun. 136(7):2092-2100. [Medline].

  34. Mosnier JF, Larvol L, Barge J, Dubois S, De La Bigne G, Henin D, et al. Lymphocytic and collagenous colitis: an immunohistochemical study. Am J Gastroenterol. 1996 Apr. 91(4):709-13. [Medline].

  35. Mullhaupt B, Guller U, Anabitarte M, Guller R, Fried M. Lymphocytic colitis: clinical presentation and long term course. Gut. 1998 Nov. 43(5):629-33. [Medline].

  36. Pardi DS. After budesonide, what next for collagenous colitis?. Gut. 2009 Jan. 58(1):3-4. [Medline].

  37. Pardi DS. Microscopic colitis. Gastroenterol & Hepatol. April 2009. 5(4):283-288.

  38. Pardi DS. Microscopic colitis. Mayo Clin Proc. 2003 May. 78(5):614-6; quiz 616-7. [Medline].

  39. Pardi DS, Loftus EV Jr, Smyrk TC, Kammer PP, Tremaine WJ, Schleck CD, et al. The epidemiology of microscopic colitis: a population based study in Olmsted County, Minnesota. Gut. 2007 Apr. 56(4):504-8. [Medline].

  40. Pardi DS, Ramnath VR, Loftus EV Jr, Tremaine WJ, Sandborn WJ. Lymphocytic colitis: clinical features, treatment, and outcomes. Am J Gastroenterol. 2002 Nov. 97(11):2829-33. [Medline].

  41. Schiller LR. Chronic diarrhea. Gastroenterology. 2004 Jul. 127(1):287-93. [Medline].

  42. Shah V, Lyford G, Gores G, Farrugia G. Nitric oxide in gastrointestinal health and disease. Gastroenterology. 2004 Mar. 126(3):903-13. [Medline].

  43. Taha Y, Raab Y, Larsson A, Carlson M, Loof L, Gerdin B, et al. Vascular endothelial growth factor (VEGF)--a possible mediator of inflammation and mucosal permeability in patients with collagenous colitis. Dig Dis Sci. 2004 Jan. 49(1):109-15. [Medline].

  44. Zins BJ, Sandborn WJ, Tremaine WJ. Collagenous and lymphocytic colitis: subject review and therapeutic alternatives. Am J Gastroenterol. 1995 Sep. 90(9):1394-400. [Medline].

  45. Colussi D, Salari B, Stewart KO, et al. Clinical characteristics and patterns and predictors of response to therapy in collagenous and lymphocytic colitis. Scand J Gastroenterol. 2015. 50 (11):1382-8. [Medline].

Previous
Next
 
Lymphocytic colitis (LC) showing marked chronic inflammatory cell infiltrate of the surface epithelium (on right) with preservation of crypt architecture. Subepithelial collagen layer is not thickened.
Collagenous colitis (CC) showing similar inflammatory cell infiltration as in lymphocytic colitis (LC), with the characteristically thickened subepithelial collagen layer.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.