II. Epidemiology

  1. More common in older patients (age 50 years old and older)
  2. Causes 10% of Chronic Diarrhea cases
    1. Causes 10-15% of all Secretory Diarrhea
  3. Gender
    1. Women account for most cases
  4. Age 60 years is typical (<45 years in 25% of cases)

III. Risk Factors: Medications

IV. Associated Conditions

  1. Irritable Bowel Syndrome
    1. Microscopic Colitis is present in 5-10% of Irritable Bowel Syndrome
  2. Celiac Disease

V. Symptoms

VI. Labs

  1. Stool studies without microscopic blood or mucus

VII. Associated Conditions

  1. Celiac Sprue (5% of cases)

VIII. Diagnosis: Colonoscopy findings

  1. Normal gross appearance
  2. Biopsy of transverse colon (random biopsies) confirms diagnosis with one of two histologic patterns
    1. Lymphocytic Colitis
      1. Lamina propria with lymphocytic infiltrate
    2. Collagenous Colitis
      1. Subepithelial Collagen layer increased >10mm

IX. Management

  1. Discontinue predisposing medications (esp. NSAIDs)
    1. Stop NSAIDs
    2. Stop Proton Pump Inhibitors (e.g. Omeprazole)
    3. Stop Statins
    4. Stop Selective Serotonin Reuptake Inhibitor
  2. Mild Symptoms
    1. Treat as Diarrhea predominant Irritable Bowel Syndrome
    2. Cholestyramine 4 grams qhs to 6 times daily
    3. Loperamide (Imodium) 2-4 mg four times daily prn (primarily before meals)
    4. Diphenoxylate
    5. Bismuth Subsalicylate
  3. Moderate Symptoms
    1. Budesonide AND
    2. Mild symptom management options
  4. Severe Symptoms
    1. Immunomodulators (6-Mercaptopurine, Methotrexate, Azathioprine, Infliximab)

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Related Studies

Ontology: Colitis, Collagenous (C0238067)

Definition (NCI) A type of microscopic colitis of unknown etiology. It is characterized by the presence of collagen deposits in the lamina propria of the colonic mucosa. Patients present with chronic watery diarrhea. Colonoscopy reveals normal-appearing mucosa. The diagnosis is made with the microscopic examination of the colonic biopsy samples.
Definition (MSH) A subtype of MICROSCOPIC COLITIS, characterized by chronic watery DIARRHEA of unknown origin, a normal COLONOSCOPY but abnormal histopathology on BIOPSY. Microscopic examination of biopsy samples taken from the COLON show larger-than-normal band of subepithelial COLLAGEN.
Concepts Disease or Syndrome (T047)
MSH D046729
ICD10 K52.89
SnomedCT 19311003
Swedish Kolit, kollagenös
Czech kolitida kolagenní, Kolagenní kolitida
Finnish Kollageenikoliitti
Russian KOLIT KOLLAGENOVYI, КОЛИТ КОЛЛАГЕНОВЫЙ
English collagenous colitis, collagenous colitis (diagnosis), Colitis, Collagenous [Disease/Finding], colitis collagenous, Colitis collagenous, Collagenous colitis, CC - Collagenous colitis, Collagenous colitis (disorder), Collagenous Colitis, Colitis, Collagenous
Japanese 大腸炎-コラーゲン, コラーゲン蓄積大腸炎, コラーゲン大腸炎, 大腸炎-コラーゲン蓄積性, 膠原性大腸炎, コウゲンセイダイチョウエン
Polish Zapalenie okrężnicy kolagenowe
Spanish Colitis colagénica, colitis colagenosa (trastorno), colitis colagenosa, Colitis Colagenosa
Portuguese Colite colagenosa, Colite Colagenosa
Dutch collagene colitis, Colitis, collageneuze
German Kolitis kollagen, Kolitis, kollagene, Kollagene Kolitis, Kollagenkolitis
Hungarian Collagen colitis
Norwegian Kollagen kolitt, Kolitt, kollagen
French Colite collagène
Italian Colite collagena

Ontology: Colitis, Lymphocytic (C0400822)

Definition (NCI) Microscopic colitis characterized by the accumulation of lymphocytes in the colonic epithelium and lamina propria. Patients present with chronic watery diarrhea. Colonoscopy reveals normal colonic mucosa. The diagnosis is made with the microscopic examination of the colonic biopsy samples.
Definition (MSH) A subtype of MICROSCOPIC COLITIS, characterized by chronic watery DIARRHEA of unknown origin, a normal COLONOSCOPY but abnormal histopathology on BIOPSY. Microscopic examination of biopsy samples taken from the COLON show infiltration of LYMPHOCYTES in the superficial EPITHELIUM and the underlying connective tissue (lamina propria).
Concepts Disease or Syndrome (T047)
MSH D046730
ICD10 K52.89
SnomedCT 31437008
Swedish Kolit, lymfocytär
Czech kolitida lymfocytární, Lymfocytická kolitida
Finnish Lymfosyyttikoliitti
Russian KOLIT LIMFOTSITARNYI, КОЛИТ ЛИМФОЦИТАРНЫЙ
English lymphocytic colitis, lymphocytic colitis (diagnosis), Colitis, Lymphocytic [Disease/Finding], colitis lymphocytic, Lymphocytic-plasmacytic colitis, Lymphocytic colitis, Lymphocytic-plasmacytic colitis (disorder), Lymphocytic Colitis, Colitis, Lymphocytic
Japanese リンパ球性大腸炎, リンパ球性結腸炎, 結腸炎-リンパ球性, 大腸炎-リンパ球性, リンパキュウセイダイチョウエン
Polish Zapalenie okrężnicy limfocytowe
Spanish Colitis linfocítica, colitis plasmocítica - linfocítica (trastorno), colitis plasmocítica - linfocítica, Colitis Linfocítica
Portuguese Colite linfocítica, Colite Linfocítica
Dutch lymfocytische colitis, Colitis, lymfocytaire
German lymphozytische Kolitis, Kolitis, lymphozytäre, Lymphozytäre Kolitis
Hungarian Lymphocytás colitis
Italian Colite linfocitaria, Colite linfocitica
Norwegian Kolitt, lymfocytær, Lymfocytær kolitt
French Colite lymphocytaire