Collagenous and lymphocytic colitis

Department of Pathology, University of Alabama School of Medicine, Birmingham 35429, USA.
Seminars in Diagnostic Pathology (Impact Factor: 2.56). 12/2005; 22(4):295-300. DOI: 10.1053/j.semdp.2006.04.006
Source: PubMed


Collagenous and lymphocytic colitis have been recognized as chronic intestinal inflammatory disorders causing watery diarrhea, which have been recognized in the past three to two decades, respectively. Collagenous colitis is primarily a disorder of middle-aged women and is characterized on biopsy by increased subepithelial collagen as well as increased inflammatory cells in the lamina propria and increased intraepithelial lymphocytes. Key to the correct diagnosis in this condition is recognizing that there are two words in this diagnostic entity, and colitis is, by definition, present. Focusing solely on the collagen band can result in both over- and underdiagnosis. Newer therapeutic options are available in this condition, and patients are now frequently being treated either with budesonide or with high dose bismuth preparations. Whereas collagenous colitis is a tightly coherent clinical pathologic entity, lymphocytic colitis has a more varied clinical picture. Lymphocytic colitis is also seen in middle-aged patients but has a more equal female-to-male ratio. Lymphocytic colitis is defined by increased intraepithelial lymphocytes, with the median being 30 lymphocytes per 100 epithelial cells. There are also an increase in inflammatory cells in the lamina propria, but the increase may be milder than in collagenous colitis and there are usually minimal eosinophils. Although numerous studies have described lymphocytic colitis causing a chronic diarrhea, more recent studies suggest that patients may have a single attack in approximately 60% of cases. Although most cases of lymphocytic colitis are idiopathic, there is a clear association with multiple drugs, celiac disease, and there may be an infectious trigger. Approximately 10% of lymphocytic colitis patients have a positive family history of some type of inflammatory intestinal disease, including ulcerative colitis, Crohn's disease, collagenous colitis, and celiac disease. Therapy in lymphocytic colitis is less well studied, but the same medications are used with success, including budesonide and high dose bismuth.

5 Reads
  • Source
    • "Microscopic colitis (MC) is an inflammatory disorder of the colonic mucosa, which causes gastrointestinal symptoms, but has a normal or near-normal endoscopic appearance [1]. Collagenous colitis (CC) (increased thickness of the subepithelial collagen band with or without increased intraepithelial lymphocytes (IEL)) and lymphocytic colitis (LC) (>20 IEL/100 enterocytes) are the two recognized forms [2]. Lymphocytic disorders of the gastrointestinal tract can be caused by a variety of different entities, e.g. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Microscopic colitis (MC) induces gastrointestinal symptoms, which are partly overlapping with irritable bowel syndrome (IBS), predominately in middle-aged and elderly women. The etiology is unknown, but association with smoking has been found. The aim of this study was to examine whether the increased risk for smokers to develop MC is a true association, or rather the result of confounding factors. Therefore, patients suffering from MC and population-based controls from the same geographic area were studied regarding smoking- and alcohol habits, and other simultaneous, lifestyle factors, concerning the clinical expression of the disease. Women at the age of 73 years or younger, who had been treated for biopsy-verified MC at any of the Departments of Gastroenterology in Skane, between 2002 and 2010, were invited to the study (240 patients). Women (737) from the population-based prospective cohort study, Malmo Diet and Cancer Study (MDCS), served as controls. A self-administered questionnaire about lifestyle factors, gastrointestinal symptoms, medical conditions and medication at the time for the study was sent by post. Altogether, 131 women with MC could be included after age-matching with controls (median age 56 years) and exclusion of secondary MC. Patients were divided into persistent MC (MC1) and transient MC (MC2). Past smoking was associated with increased risk to develop MC2 (OR = 2.67, 95 CI = 1.15-6.23), whereas current smoking was associated with increased risk to develop MC1 (OR = 3.18, 95 CI = 1.57-6.42). Concomitant symptoms of IBS were associated with smoking (OR = 4.24, 95 CI = 1.92-9.32). Alcohol drinking had no association with MC or IBS. The results suggest that past smoking is associated with transient MC, whereas current smoking is associated with persistent MC. Smoking is associated with MC patients with concomitant IBS-like symptoms.
    BMC Women's Health 01/2014; 14(1):16. DOI:10.1186/1472-6874-14-16 · 1.50 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Die mikroskopische Kolitis (MC) ist eine häufige Ursache chronischer, nicht blutiger Durchfälle mit steigender Inzidenz in den letzten Jahren. Die Diagnose stützt sich auf die histologischen Veränderungen, mit der zwei Subtypen, die lymphozytäre (LC) und die kollagene Kolitis (CC), unterschieden werden können. Das Hauptcharakteristikum der LC ist die erhöhte Anzahl intraepithelialer Lymphozyten (IEL). In der Literatur werden >20 IEL/100 Epithelien für die Diagnose LC gefordert. Bei den intraepithelialen Lymphozyten handelt es sich vornehmlich um zytotoxische Lymphozyten (CD8+). Das Hauptkriterium der CC ist ein kontinuierliches subepitheliales Kollagenfaserband unterhalb des Oberflächenepithels (Breite >10 µm), das Kapillaren, Erythrozyten und Entzündungszellen enthalten kann. Das Oberflächenepithel zeigt häufig regressive Veränderungen und kann teilweise von der Basalmembran abgehoben sein. Beide Formen der mikroskopischen Kolitis (LC und CC) zeigen einen vermehrten lymphoplasmazellulären Zellbesatz in der Lamina propria mucosae, auch eosinophile und neutrophile Granulozyten können vorhanden sein. Diese Veränderungen in der Lamina propria mucosae sind uncharakteristisch und reichen für die Diagnose einer mikroskopischen Kolitis nicht aus, auch wenn das entzündliche Infiltrat der Lamina propria möglicherweise für die klinischen Symptome verantwortlich ist. Der Begriff MCi („MC incomplete“) wurde für eine Patientengruppe mit chronischer Diarrhö und einem vermehrten lymphoplasmazellulären Zellbesatz in der Lamina propria vorgeschlagen, welche die Kriterien für eine LC (>20 IEL/100 Epithelien) bzw. eine CC (>10 µm Kollagenfaserband) nicht ganz erfüllt. Diese Kriterien sind jedoch insgesamt noch uneinheitlich und in klinischen Studien zu überprüfen.
    Der Pathologe 11/2012; 33(2). DOI:10.1007/s00292-012-1694-5 · 0.39 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: La colite lymphocytaire (CL), entité rare rentrant dans le cadre anatomoclinique des colites microscopiques (CM), est une maladie inflammatoire de la muqueuse colique. Le pathologiste joue un rôle clé dans le diagnostic de ces CL tout en éliminant un certain nombre de diagnostics différentiels. Toutefois, il convient de faire une confrontation anatomoclinique entre l’histologie qui parle et l’information clinique qui donne la clé pour une interprétation correcte. La majorité des travaux récents permet des progrès dans les connaissances histopathogéniques, étiologiques et thérapeutiques des CL. Cependant, le débat quant à la distinction CL/colite collagène (CC), et dans lequel le pathologiste joue un rôle crucial, est toujours d’actualité. Ainsi, le diagnostic de CM est purement anatomopathologique ; il repose sur l’examen anatomopathologique de biopsies coliques systématiques avec une corrélation entre les manifestations cliniques du malade, ayant une diarrhée chronique et une endoscopie normale, et l’aspect histologique des biopsies mettant en évidence des lésions de CL. À travers ce travail, nous allons essayer de souligner l’apport du pathologiste dans le diagnostic positif et différentiel des CL et discuter les interactions entre clinicien et pathologiste.
    Acta Endoscopica 10/2011; 41(5). DOI:10.1007/s10190-011-0199-z · 0.16 Impact Factor
Show more