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Read answers from our experts: Living Well | Diet & Fitness | Mental Health | Conditions
updated October 02, 2010

Collagenous colitis, lymphocytic colitis

Filed under: Digestive Health
Collagenous (kuh-LAYJ-uh-nus) colitis and lymphocytic colitis are inflammatory conditions of the colon that cause persistent watery diarrhea. Some researchers believe that collagenous colitis and lymphocytic colitis are different phases of the same condition rather than separate conditions.

Both collagenous colitis and lymphocytic colitis are sometimes referred to collectively as microscopic colitis — because the diagnosis is confirmed by examining a sample of tissue using a microscope.

Treatment for collagenous colitis and lymphocytic colitis often begins with lifestyle changes. In many cases, adjusting your diet will be enough to resolve your symptoms. If not, your doctor can suggest a number of effective medications for collagenous colitis and lymphocytic colitis. In rare cases, surgery is necessary.

©1998-2013 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
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Signs and symptoms of collagenous colitis and lymphocytic colitis include:

  • Chronic, watery diarrhea
  • Abdominal pain or cramps
  • Weight loss
  • Nausea
  • Fecal incontinence

When to see a doctor
If you have watery diarrhea that lasts more than a few days, contact your doctor so that the condition can be diagnosed and properly treated.

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It's not clear what causes collagenous colitis and lymphocytic colitis. The inflammation affects the colon differently in the two types of colitis:

  • Collagenous colitis causes the layer of connective tissue (collagen) in the colon to thicken.
  • Lymphocytic colitis causes increased levels of a specialized type of white blood cell (lymphocyte) in the colon.

Theories about causes
Doctors aren't sure what causes collagenous colitis and lymphocytic colitis, but researchers theorize that causes could include:

  • Bacteria that produce toxins that irritate the lining of the colon.
  • Viruses that trigger inflammation.
  • Immune system problems, such as autoimmune disorders that occur when the body's immune system attacks healthy tissues. People with collagenous colitis or lymphocytic colitis sometimes also have an autoimmune disorder, such as celiac disease, rheumatoid arthritis or scleroderma.

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Some research studies indicate that using certain medications may increase your risk of collagenous colitis and lymphocytic colitis. But not all studies agree. Medications linked to these conditions include:

  • Clozapine (Clozaril)
  • Entacapone (Comtan)
  • Esomeprazole (Nexium)
  • Flutamide
  • Lansoprazole (Prevacid)
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen (Advil, Motrin, others)
  • Omeprazole (Prilosec)
  • Ranitidine (Zantac)
  • Sertraline (Zoloft)
  • Simvastatin (Zocor)
  • Ticlopidine (Ticlid)

It's not clear why some people who use these medications develop collagenous colitis or lymphocytic colitis, while others don't.

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Make an appointment with your family doctor or a general practitioner if you have signs and symptoms that worry you. If your doctor suspects you may have a problem in your colon, such as collagenous colitis or lymphocytic colitis, you'll likely be referred to a doctor who specializes in digestive system problems (gastroenterologist).

Because appointments can be brief, it's a good idea to be well prepared. Here's some information to help you get ready, and what to expect from your doctor.

What you can do

  • Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance. For example, you may need to avoid solid foods in the day leading up to your appointment.
  • Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment. Your doctor will want to know how many watery bowel movements you're having each day and whether there is any blood in your stools.
  • Write down key personal information, including any major stresses or recent life changes. Also include a detailed description of your typical daily diet, including whether you usually use caffeine and alcohol.
  • Make a list of your key medical information, including other conditions for which you've recently been treated. Write down the names of every prescription and over-the-counter drug you are currently taking or have recently taken, including antibiotics and any vitamins and supplements. Also mention if you have been hospitalized in the last few months.
  • Take a family member or friend along, if possible. Sometimes it can be difficult to absorb all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
  • Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out.

For collagenous colitis or lymphocytic colitis, some basic questions to ask your doctor include:

  • What is likely causing my symptoms or condition?
  • Are there any other possible causes for my symptoms or condition?
  • Do you think my condition is temporary or chronic?
  • What kinds of tests do I need? Will I need a biopsy?
  • What treatment approach do you recommend?
  • If the first type of treatment doesn't improve my symptoms, what will you recommend next?
  • Is there anything I can do to prevent a recurrence of this problem?
  • Am I at risk of long-term complications from this condition?
  • Are there any restrictions that I need to follow?
  • I have these other health conditions. Do I need to change the treatments I've been using?
  • Should I see a specialist? What will that cost, and will my insurance cover it?
  • Is there a generic alternative to the medicine you're prescribing?
  • Are there any brochures or other printed material that I can take with me? What websites do you recommend?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time you don't understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over points you want to talk about in-depth. Your doctor may ask:

  • When did you begin experiencing symptoms?
  • Have your symptoms been continuous or occasional?
  • How many loose bowel movements are you having each day?
  • For how long have you been experiencing frequent diarrhea?
  • How severe are your other symptoms, such as abdominal cramping and nausea?
  • Has there been blood in your stools?
  • Have you lost any weight?
  • Have you traveled recently?
  • Is anyone else sick at home with diarrhea?
  • Have you been hospitalized or taken antibiotics in the last few months?
  • What medications are you currently taking?
  • What do you eat in a typical day?
  • Do you use caffeine or alcohol? How much?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?

What you can do in the meantime
While you're waiting for your appointment, you may find some relief from persistent diarrhea by making changes to your diet. Try to:

  • Eat low fat foods
  • Avoid dairy products
  • Not drink caffeine or alcohol
  • Choose bland foods and avoid spicy foods

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Tests and procedures used to diagnose collagenous colitis and lymphocytic colitis include:

  • Testing a sample of your stool. Your doctor may ask you to collect your stool for laboratory testing. This can help rule out an infection, which can also cause persistent diarrhea.
  • Using a scope to examine inside your colon. Your doctor may use a long, thin tube with a camera on the end to examine the inside of your colon. If the tube is used to view your entire colon, the procedure is called colonoscopy. Using the tube to see only the lower portion of your colon is called flexible sigmoidoscopy. People with collagenous colitis and lymphocytic colitis have normal-appearing colons.
  • Collecting a sample of colon tissue for testing. During a colonoscopy or flexible sigmoidoscopy, the doctor can pass special surgical tools through the tube to collect one or more small samples of colon tissue. The tissue is tested in a laboratory to look for signs of disease.

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Many cases of collagenous colitis and lymphocytic colitis get better on their own without treatment. However, when the signs and symptoms are serious, treatment may be necessary. Treatment is the same for both collagenous colitis and lymphocytic colitis. Doctors usually recommend a stepwise approach, starting with the simplest, most easily tolerated treatments. The goal is to produce the relief of symptoms.

Diet and medication changes to relieve diarrhea
Treatment usually begins with changes to your diet and medications that may help relieve persistent diarrhea. Your doctor may recommend that you:

  • Eat a low-fat, low-fiber diet. Choose foods that contain less fat and foods that are low in fiber. This may help relieve diarrhea.
  • Avoid NSAID pain relievers. If you regularly take over-the-counter pain relievers thought to contribute to collagenous colitis and lymphocytic colitis, your doctor may recommend a different medication.

If your signs and symptoms persist, your doctor may recommend medications, such as:

  • Anti-diarrhea drugs. Medications that control diarrhea include loperamide (Imodium A-D), bismuth subsalicylate (Pepto-Bismol) and a combination of the drugs diphenoxylate and atropine (Lomotil).
  • Drugs that block bile acids. The drug cholestyramine (Questran) may help treat lymphocytic colitis by absorbing bile acids that can contribute to diarrhea.
  • Steroid medications to block inflammation. A corticosteroid drug, such as budesonide (Entocort) or prednisone, can help control inflammation in your colon.
  • Anti-inflammatory drugs. Other drugs used to control colon inflammation include mesalamine (Asacol, Pentasa, others) and sulfasalazine (Azulfidine).
  • Drugs that suppress the immune system. Immunosuppressive drugs that can help reduce inflammation in the colon include methotrexate (Rheumatrex) and azathioprine (Azasan, Imuran).

Surgery to remove a portion of your colon
When the symptoms of collagenous colitis and lymphocytic colitis are severe, and medications aren't effective, your doctor may recommend surgery to remove all or part of your colon in a procedure called a colectomy. Surgery is rare for these conditions.

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Changes to your diet may help relieve diarrhea that you experience with collagenous colitis and lymphocytic colitis. Try to:

  • Drink plenty of fluids. Water is best, but fluids with added sodium and potassium (electrolytes) may be beneficial as well. Try drinking broth or watered-down fruit juice. Avoid beverages that are high in sugar or contain alcohol or caffeine, such as coffee, tea and colas, which may aggravate your symptoms.
  • Choose soft, easy-to-digest foods. These include applesauce, bananas and rice. Avoid high-fiber foods such as beans, nuts and vegetables. If you feel like your symptoms are improving, slowly add high-fiber foods back to your diet.
  • Try eating several small meals, rather than a few large meals. Space meals throughout the day instead of eating two or three large ones.
  • Avoid irritating foods. Stay away from spicy, fatty or fried foods and any other foods that make your symptoms worse.

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