Overview

Lymphocytic colitis is a type of microscopic colitis, a condition characterized by chronic inflammation of the colon (large intestine) that is only visible under a microscope. Unlike other forms of colitis, lymphocytic colitis does not cause visible inflammation during a colonoscopy, which is why it often requires a tissue biopsy for diagnosis. This condition is marked by an increased number of lymphocytes (a type of white blood cell) in the colon lining, leading to persistent, watery diarrhea. Lymphocytic colitis commonly affects middle-aged and older adults and tends to occur more frequently in women than in men. While it can cause significant discomfort, it is not considered a life-threatening condition and typically responds well to treatment.

Causes

The exact cause of lymphocytic colitis is not fully understood, but several factors are thought to contribute to its development:

• Autoimmune Disorders: Lymphocytic colitis is more common in individuals with autoimmune diseases, such as rheumatoid arthritis, celiac disease, or thyroid disorders, suggesting an immune-mediated mechanism.
• Medications: Certain medications, including nonsteroidal anti-inflammatory drugs (NSAIDs), proton pump inhibitors (PPIs), selective serotonin reuptake inhibitors (SSRIs), and statins, have been linked to the onset of lymphocytic colitis.
• Infections: Gastrointestinal infections, especially bacterial infections, may trigger an immune response that leads to colonic inflammation.
• Smoking: Cigarette smoking is a known risk factor associated with a higher incidence of lymphocytic colitis.
• Genetics: A genetic predisposition may play a role, especially in individuals with a family history of inflammatory bowel disease or autoimmune conditions.
• Environmental Triggers: Other environmental factors, such as dietary components or exposure to toxins, may contribute in susceptible individuals.

Symptoms

Lymphocytic colitis primarily affects bowel habits, leading to a range of gastrointestinal symptoms, most notably:

• Chronic Watery Diarrhea: Frequent, non-bloody, watery stools occurring several times per day, sometimes including nighttime diarrhea.
• Abdominal Pain and Cramping: Mild to moderate discomfort, often relieved after bowel movements.
• Urgency: A sudden, urgent need to have a bowel movement, which can be socially disruptive.
• Bloating: A feeling of abdominal fullness or swelling.
• Fatigue: Ongoing diarrhea and nutrient malabsorption can lead to generalized tiredness and weakness.
• Weight Loss: Some individuals may experience unintended weight loss due to frequent bowel movements and reduced appetite.

It’s important to note that lymphocytic colitis does not typically cause bleeding, and the colon's appearance remains normal during standard endoscopic examination.

Diagnosis

Diagnosing lymphocytic colitis requires a thorough evaluation, as its symptoms overlap with other gastrointestinal disorders. The diagnostic process includes:

• Medical History and Physical Exam: A detailed review of symptoms, medication use, smoking history, and associated conditions.
• Stool Studies: Tests to rule out infectious causes of diarrhea, such as bacterial, viral, or parasitic infections.
• Blood Tests: May show signs of mild inflammation, dehydration, or nutrient deficiencies, but are often nonspecific.
• Colonoscopy: The colon appears normal to the naked eye, but biopsies are taken from multiple areas of the colon.
• Histological Examination: Microscopic analysis of colon tissue biopsies shows an increased number of lymphocytes in the lining of the colon, confirming the diagnosis of lymphocytic colitis.

Treatment

The treatment of lymphocytic colitis focuses on relieving symptoms, reducing inflammation, and improving quality of life. Treatment options include:

Lifestyle and Dietary Modifications

• Dietary Adjustments: Avoiding foods that trigger symptoms, such as lactose, caffeine, fatty foods, and artificial sweeteners.
• Hydration: Ensuring adequate fluid intake to prevent dehydration from chronic diarrhea.
• Smoking Cessation: Quitting smoking can improve symptoms and reduce flare-ups.
• Medication Review: Discontinuing medications that may contribute to the condition, under the guidance of a healthcare provider.

Medications

• Antidiarrheal Agents: Medications like loperamide can help manage mild diarrhea symptoms.
• Bile Acid Binders: Cholestyramine may be useful if bile acid malabsorption is contributing to diarrhea.
• Corticosteroids: Budesonide, a locally acting steroid with fewer systemic side effects, is often used as the first-line treatment for moderate to severe cases.
• Aminosalicylates: Sometimes used, though evidence for their effectiveness is limited compared to budesonide.
• Immunosuppressive Drugs: Rarely needed but considered in refractory cases, medications like azathioprine may be used under specialist supervision.

Prognosis

The prognosis for lymphocytic colitis is generally favorable. Many individuals experience periods of remission and symptom relief with appropriate treatment. Budesonide is particularly effective in inducing remission in most patients. Relapses can occur, but symptoms are usually manageable with intermittent or ongoing treatment.

Lymphocytic colitis does not increase the risk of colorectal cancer and is not associated with life-threatening complications. With proper management, most people lead normal, healthy lives. Long-term follow-up with healthcare providers helps monitor symptoms, adjust treatments, and maintain quality of life.