Introduction

Lymphocytic colitis is one of two main types of microscopic colitis, and is an inflammatory bowel disease, meaning the large bowel is affected; the large bowel includes the colon and the rectum.^1,2 Collagenous colitis is the other main type of microscopic colitis. The function of the large intestine is to break down the food from the small intestine and reabsorb water and electrolytes.² The term microscopic colitis means it is detectable only via a microscope. Lymphocytic colitis is a chronic condition and arises from inflamed white blood cells called lymphocytes. It is recognised through a significantly large number of lymphocytes in the intestinal lining. This condition is an autoimmune disease which occurs when the immune system becomes overactive and unable to correctly distinguish infections in the body, therefore attacking the body’s own cells in the digestive system.³

Causes and risk factors of Lymphocytic colitis

Lymphocytic colitis is more common in older adults, although can still be present in younger people, as well as it is more common in people born as females than people born as males.² The most common appearances are in people aged between 60 and 80 years.⁴ This condition has a number of triggers to watch out for including allergies that can impact your gut, over-use or frequent use of medications such as ibuprofen, aspirin, medicines for diabetes, depression, acid reflux, and high cholesterol, smoking and a prior viral or bacterial infection of your gut.^2,3 If these substances are present in the gastrointestinal tract, an abnormal immune response may be triggered. Food is not known to directly cause the condition; however, certain foods may exacerbate or worsen symptoms of lymphatic colitis. An example of these foods could be caffeine or dairy. Smoking increases the likelihood of a diagnosis of lymphocytic colitis because it interferes with the blood flow that the intestines require. A patient with certain health issues or other autoimmune diseases may increase their risk, including diabetes, irritable bowel syndrome, particular types of thyroid disease and celiac disease. Genetic history can also contribute to the risk.²

Symptoms of Lymphocytic colitis

As lymphocytic colitis affects the cellular composition of the large bowel lining, a major symptom is frequent and watery diarrhoea, usually between 5-10 times a day. The inflammation prevents the large intestine from reabsorbing as much water from the waste as it should, leading to an imbalance of chemicals in the gut and more fluid build-up, producing large amounts of watery diarrhoea.^1,2 This diarrhoea can subsequently cause abdominal cramps and discomfort and faecal incontinence, which is the inability to manage bowel motions, leading to severe dehydration, fatigue and weight loss. As the epithelium, which is the outer lining of the colon, is unaffected, there is no mucus or blood present in the diarrhoea.⁴ Various other symptoms of lymphocytic colitis include nausea, weakness and bloating. A lymphocytic flareup, which is the presence of symptoms, can last for a few weeks or months.² Unfortunately, a secondary autoimmune disease can arise from lymphocytic colitis such as psoriasis, arthritis and uveitis. These are skin rashes, inflammation of the eye and inflammation of joints, respectively.³

Diagnosis of Lymphocytic colitis

A diagnosis will typically come from a gastroenterologist who is a specialist in the digestive tract. They may ask about medical and family history and will require you to be open about your symptoms, followed by a more physical abdominal examination. Other tests may include blood and stool tests to check for anaemia, inflammation or infection, or particular tests for celiac disease.² A more invasive way of diagnosing lymphocytic colitis includes a sample of tissue from the intestinal lining being examined under a microscope. This sample is collected via an endoscopy or colonoscopy performed by a gastroenterologist, where a flexible instrument is manoeuvred through the colon.³ This instrument is fitted with a camera, which will show normal results for lymphocytic colitis. The biopsy of the sample, however, will show an abnormal number of lymphocytes which are responsible for the inflammation found. Whether the patient will undergo an endoscopy or colonoscopy will depend on which part of the digestive tract the sample will come from. Prior to either of these procedures, the patient will need to prepare their colon by only having certain foods and drinks to ensure the colon is clear enough to provide a sample.⁵ Another way of diagnosis will be through blood and stool tests.³

Treatment of Lymphocytic colitis

Treating lymphocytic colitis varies from patient to patient depending on the severity. Some require lifestyle changes while some require medication and will likely require trying a variety to determine the one that is most suitable to you.³ Lifestyle changes involve diet changes; particularly, avoiding any foods that make your symptoms worse. These could include high-fat foods, sweeteners, dairy, alcohol and caffeine. If patients also have celiac disease, it is recommended that they follow a gluten-free diet. In addition to dietary changes, the patient should consider quitting smoking, managing stress, exercising and starting intermittent fasting.⁶ Prescription medication can involve antidiarrheal medications to control diarrhoea, or biological medicines and to control symptoms and immunosuppressants to decrease the overactivity of the immune system.¹ Typically, patients only need to take medications for a short period until remission is reached. When a patient relapses, they will need to continue taking these again. The worst case scenario is when the patient’s body does not react well to any treatment and will therefore then have surgery to remove the affected part of the intestine. Probiotics also restore the natural balance of bacteria within the gut.²

Prevention of Lymphocytic colitis

Despite the exact cause of lymphocytic colitis not being known, there are prevention or reduction factors that you may be able to do. Use non-steroidal anti-inflammatories such as ibuprofen and aspirin carefully by reading any guidance of healthcare specialists, practise stress management techniques, drink an abundance of fluids to maintain digestive health, and live a healthy lifestyle that includes regular exercise, a balanced diet and avoid  excess  alcohol and smoking.⁷

Outlook with Lymphocytic colitis

While there is no permanent cure for lymphocytic colitis, the patient can enter remission which is when symptoms are at ease and the inflammation is lowered. Remission can occur gradually or spontaneously, depending on the patient’s course of treatment or lifestyle changes.³ Lymphocytic colitis does not increase the patient’s risk of colon cancer or affect survival rates, because the condition does not cause serious or long-lasting damage to the colon.^2,3 As the symptoms can have an impact on your day-to-day life, it can affect your social life and make you feel isolated.¹ Stress can also exacerbate the symptoms of lymphocytic colitis and cause a flare-up, therefore learning techniques on how to manage your stress is very important. These may include yoga, meditation, relaxing or practising mindfulness.⁸

Some complications that can occur if the lymphocytic colitis goes without treatment are malnutrition, dehydration, malabsorption of nutrients and weight loss.⁴

FAQs

How do I know the difference between lymphocytic colitis and collagenous colitis?

Lymphocytic colitis is characterised by an abnormally high number of lymphocytes present in the lining of the colon. The distinguishing factor between the two is the fact that in collagenous colitis, the subepithelial collagen layer is much thicker than normal. Both trigger the same symptoms and have the same causes, but the biopsy results for both show different results.³

Can lymphocytic colitis lead to other types of colitis?

It is not known to be related to other types of inflammatory bowel diseases or colitis conditions, as it does not cause significant damage to the colon. This also means there is no increased risk of cancer.⁴

Is there any test I can take to determine if genetic factors contribute to my diagnosis?

Currently, no specific test can be taken. The diagnosis is based on symptoms, procedures and examination of biopsy results. If there is an appropriate medical history, it is likely to have had some contribution.²

Summary

Lymphocytic colitis is a chronic condition involving the colon but is not life-threatening. It is important for patients to understand lymphocytic colitis in order to manage and control symptoms. Through medication, lifestyle changes and specialist care, patients can have a good quality of life. If you experience any of the symptoms, consult a healthcare professional for suitable diagnosis and treatment.