II. Epidemiology
- More common in older patients (age 50 years old and older)
- Causes 10% of Chronic Diarrhea cases
- Causes 10-15% of all Secretory Diarrhea
- Gender
- Women account for most cases
- Age 60 years is typical (<45 years in 25% of cases)
III. Risk Factors: Medications
- NSAID use for longer than 6 months
- Aspirin
- Statins
- Proton Pump Inhibitors
- Selective Serotonin Reuptake Inhibitors (SSRI)
IV. Associated Conditions
-
Irritable Bowel Syndrome
- Microscopic Colitis is present in 5-10% of Irritable Bowel Syndrome
- Celiac Disease
V. Symptoms
-
Chronic Watery Diarrhea
- Secretory Diarrhea (Diarrhea day and night regardless of Fasting)
- Abdominal Pain
- Weight loss
- Arthralgias
- Fatigue
VI. Labs
- Stool studies without microscopic blood or mucus
VII. Associated Conditions
- Celiac Sprue (5% of cases)
VIII. Diagnosis: Colonoscopy findings
- Normal gross appearance
- Biopsy of transverse colon (random biopsies) confirms diagnosis with one of two histologic patterns
- Lymphocytic Colitis
- Lamina propria with lymphocytic infiltrate
- Collagenous Colitis
- Subepithelial Collagen layer increased >10mm
- Lymphocytic Colitis
IX. Management
- Discontinue predisposing medications (esp. NSAIDs)
- Stop NSAIDs
- Stop Proton Pump Inhibitors (e.g. Omeprazole)
- Stop Statins
- Stop Selective Serotonin Reuptake Inhibitor
- Mild Symptoms
- Treat as Diarrhea predominant Irritable Bowel Syndrome
- Cholestyramine 4 grams qhs to 6 times daily
- Loperamide (Imodium) 2-4 mg four times daily prn (primarily before meals)
- Diphenoxylate
- Bismuth Subsalicylate
- Moderate Symptoms
- Budesonide AND
- Mild symptom management options
- Severe Symptoms
- Immunomodulators (6-Mercaptopurine, Methotrexate, Azathioprine, Infliximab)
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Related Studies
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 |