eMedicine Specialties > Gastroenterology > Colon

Collagenous and Lymphocytic Colitis: Follow-up

Author: Eric Goosenberg, MD, Clinical Assistant Professor, Department of Medicine, Drexel University School of Medicine
Contributor Information and Disclosures

Updated: Jul 15, 2009

Follow-up

Prognosis

  • Approximately 20% of patients may have a spontaneous remission without specific therapy.
  • More than half of patients treated for LC experienced resolution of symptoms after 6 months of treatment, while only 15% of patients had significant persistent symptoms.
  • In some patients, the diarrhea may wax and wane over many years; however, more than 80% of patients can expect diarrhea and histologic abnormalities to resolve within 3 years.
  • Rare cases with severe and protracted diarrhea have been fatal; these cases are likely thought to be due to epithelial membrane sloughing and resultant altered mucosal permeability.
  • Although some small studies have suggested otherwise, microscopic colitis (either CC or LC) does not appear to increase the risk of colon cancer.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Patients who fail to respond to reasonable medical therapy should be evaluated for other conditions that may mimic LC or CC clinically.
  • The adverse effects of corticosteroids and immunosuppressants/immunomodulators may be serious. Such drugs would be difficult to justify in a patient later found to have irritable bowel syndrome or infectious or other causes of colitis or enteritis that should have been treated differently.
  • Performing a colonoscopy on patients with chronic diarrhea is commonly accepted and widely practiced, but performing biopsies in all such individuals, even with normal findings on endoscopy, has a low yield. Patients clinically assessed as having diarrhea-predominant irritable bowel syndrome who do not respond to conventional medical therapy may in fact have microscopic colitis, and these patients may benefit from colonoscopy with biopsies.
    • Limit biopsies to those subgroups of patients in whom microscopic colitis is most likely.
    • Those subgroups would include patients with watery, severe, debilitating, or nocturnal diarrhea; substantial weight loss; an elevated erythrocyte sedimentation rate; or patients who are immunosuppressed.

Special Concerns

  • As with the management of inflammatory bowel disease, antidiarrheal and nonimmunosuppressive medications have an acceptable risk in pregnant patients when clinical symptoms are significant and might threaten pregnancy.
  • Methotrexate may induce spontaneous abortion and is contraindicated during pregnancy. 6-mercaptopurine and azathioprine may cause fetal harm but so may refractory colitis. Consequently, risk versus benefit must be carefully discussed before prescribing these medications to a pregnant patient.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous coauthor Arun Chaudhary, MD, to the development and writing of this article.



More on Collagenous and Lymphocytic Colitis

Overview: Collagenous and Lymphocytic Colitis
Differential Diagnoses & Workup: Collagenous and Lymphocytic Colitis
Treatment & Medication: Collagenous and Lymphocytic Colitis
Follow-up: Collagenous and Lymphocytic Colitis
Multimedia: Collagenous and Lymphocytic Colitis
References
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Further Reading

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Keywords

collagenous colitis, CC, lymphocytic colitis, LC, microscopic colitis

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Contributor Information and Disclosures

Author

Eric Goosenberg, MD, Clinical Assistant Professor, Department of Medicine, Drexel University School of Medicine
Eric Goosenberg, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.

Medical Editor

Terence David Lewis, MBBS, FRACP, FRCPC, FACP, Program Director, Internal Medicine Residency, & Assistant Chairman, Associate Professor, Department of Internal Medicine, Division of Gastroenterology, Loma Linda University Medical Center
Terence David Lewis, MBBS, FRACP, FRCPC, FACP is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Medical Association, California Medical Association, Royal College of Physicians and Surgeons of Canada, and Sigma Xi
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Douglas M Heuman, MD, FACP, FACG, AGAF, Chief of Hepatology, Hunter Holmes McGuire Department of Veterans Affairs Medical Center; Professor, Department of Internal Medicine, Division of Gastroenterology, Virginia Commonwealth University 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: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD, Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law Medicine and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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