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Collagenous colitis and lymphocytic colitis

Collagenous colitis and lymphocytic colitis are chronic diseases in which certain kinds of white blood cells infiltrate the lining of the large intestine, leading to watery diarrhea. Microscopic colitis (MC) is a name used to describe a chronic diarrheal syndrome that is caused by inflammation in the colon/large intestine (i.e., colitis). It is called "microscopic" colitis because the inflammation can be detected only with a microscope. During an endoscope procedure (colonoscopy or

sigmoidoscopy), the colon looks normal. The presence or absence of a specific feature within the colonic inflammatory process as seen under the microscope (thickened collagen under the surface of the biopsy) has led to use of two other names for this syndrome: collagenous colitis and lymphocytic colitis.

Collagenous colitis is a rare digestive disorder that primarily affects females and typically becomes apparent during middle age. The disorder is characterized by inflammatory changes of the mucous membranes (mucosa) of the colon (colitis) and abnormal accumulation (excessive deposition) of the protein collagen beneath the surface (epithelial) layer of the mucosa (thickened subepithelial collagenous bands). The colon is the major portion of the large intestine. The medical literature often refers to collagenous colitis as a form of "microscopic colitis," since evidence of inflammation and other abnormalities may only be confirmed through microscopic (i.e., histologic) examination of multiple tissue samples. Individuals with collagenous colitis typically experience episodes of chronic, watery, nonbloody diarrhea. In some instances, episodes may often occur at night (nocturnal diarrhea). Diarrheal episodes may be persistent or may occur at intervals (intermittent) over a period of weeks, months, or years. Other symptoms and findings that may occasionally be associated with such episodes include vague abdominal pain, abdominal swelling (distension), nausea, vomiting, and/or weight loss.

Lymphocytic colitis is closely related to collagenous colitis. Both are characterized by a syndrome of watery diarrhea, usually occurring in young to middle aged women. The etiology is unknown but an autoimmune basis has long been suspected. However, an infectious etiology has not been excluded. In favor of an infectious etiology are cases associated with an outbreak of Brainerd diarrhea aboard a cruise ship. Brainerd diarrhea has been applied to cases of diarrhea of unknown etiology with an acute onset and prolonged duration. Like collagenous colitis, a chronic watery diarrhea is present, but this lasts longer than 6 months and frequently for many years. Biopsies show similar features to lymphocytic colitis except there may a lesser degree of lymphocytic infiltration.

The diagnosis of collagenous colitis or lymphocytic colitis is made after tissue samples taken during colonoscopy or flexible sigmoidoscopy are examined under a microscope. Collagenous colitis is characterized by a larger-than-normal band of protein called collagen inside the lining of the colon. The thickness of the band varies, so multiple tissue samples from different areas of the colon may need to be examined. In lymphocytic colitis, tissue samples show inflammation with white blood cells known as lymphocytes between the cells that line the colon, and in contrast to collagenous colitis, there is no abnormality of the collagen. People with collagenous colitis are most often diagnosed in their 50s, although some cases have been reported in adults younger than 45 years and in children aged 5 to 12. It is diagnosed more frequently in women than men. People with lymphocytic colitis are also generally diagnosed in their 50s. Both men and women are equally affected.

Treatment for collagenous colitis and lymphocytic colitis varies depending on the symptoms and severity of the cases. The diseases have been known to resolve spontaneously, but most patients have recurrent symptoms. Antidiarrheal drugs, such as anticholinergic drugs or small doses of loperamide or diphenoxylate, are effective for many people with these diseases. Anti-inflammatory drugs, such as salicylates (for example, bismuth subsalicylate), sulfasalazine, and mesalamine , are effective as well. Antibiotics such as metronidazole and erythromycin also seem to help, although infection has not been found to be a cause of the diseases. Corticosteroids (such as prednisone) also work well but are usually reserved for people who do not respond to other drug treatment. Lifestyle changes aimed at improving diarrhea are usually tried first. Recommended changes include reducing the amount of fat in the diet, eliminating foods that contain caffeine or lactose, and not using NSAIDs. If lifestyle changes alone are not enough, medications are often used to control the symptoms of collagenous colitis and lymphocytic colitis. Antidiarrheal medications such as bismuth subsalicylate and bulking agents reduce diarrhea.

More information on inflammatory bowel diseases (ulcerative colitis, Crohn's disease)

What are the inflammatory bowel diseases? - Inflammatory bowel disease (IBD) is a chronic disorder that causes an inflamed and swollen digestive tract or intestinal wall.
What causes inflammatory bowel diseases? - The cause of inflammatory bowel disease is not known. Chronic inflammation present in the intestines of persons with both forms of IBD damages the bowel.
What are the symptoms of inflammatory bowel diseases? - Symptoms of inflammatory bowel diseases can include chronic diarrhea, abdominal cramps or pain, fever, and blood or mucus in the stool.
How is inflammatory bowel disease diagnosed? - To make a diagnosis of inflammatory bowel disease, a doctor must first exclude other possible causes of inflammation.
What're the treatments for inflammatory bowel disease? - Inflammatory bowel disease is treated with medication, exercise, and sometimes, surgery. Treatments for IBD are directed against the inflammation in the bowel.
What're the medications for inflammatory bowel disease? - Medications for inflammatory bowel disease include sulfasalazine, corticosteroids, immunosuppressives, and nonsteroidal anti-inflammatory drugs (NSAIDs).
What is Crohn's disease? - Crohn's Disease is a chronic illness that causes irritation in the digestive tract. Crohn's disease occurs in the last portion of intestine (ileum).
What types of Crohn's disease are there? - There are five subtypes of Crohn's disease, distinguished by the gastrointestinal area in which the disease occurs.
What causes Crohn's disease? - The cause of Crohn's disease is unknown. There is now evidence of a genetic link as Crohn's frequently shows up in a family group.
What are the symptoms of Crohn's disease? - The symptoms of Crohn's disease include abdominal pain, diarrhea, fever, loss of appetite and weight loss.
What are the complications of Crohn's disease? - Common complications of Crohn's disease include the development of an intestinal obstruction, pus-filled pockets of infection, and abnormal connecting channels.
How is Crohn's disease diagnosed? - The diagnosis of Crohn's disease is suspected in patients with fever, abdominal pain and tenderness, diarrhea with or without bleeding, and anal diseases.
What're the treatments for Crohn's disease? - Treatment for Crohn's disease is mainly symptomatic. Medications are very effective at improving the symptoms of Crohn's disease.
What medications cure Crohn's disease? - Medications for Crohn's disease sulfasalazine, Asacol, Pentasa and Dipentum. Mesalamine is useful both to achieve and maintain remission.
What's the surgery for Crohn's disease treatment? - Surgery to remove part of the intestine can help Crohn's disease but cannot cure it. The most used operation in Crohn disease is removing the diseased part of the intestine.
What Crohn's disease diet is suggested? - Diet may have to be restricted based on symptoms or complications of Crohn's disease. No particular food has ever been implicated in causing Crohn's disease.
Crohn's disease in children - Crohn's disease is most often diagnosed in young adulthood. Children facing Crohn's disease have significant self-image issues to deal with.
Crohn's disease and pregnancy women - Women with Crohn's disease who are considering having children can be comforted to know that the vast majority of such pregnancies will result in normal children.
What is ulcerative colitis? - Ulcerative colitis is an inflammatory disease of the bowel, that usually affects the distal end of the large intestine and rectum.
What types of ulcerative colitis are there? - Doctors categorize ulcerative colitis by the amount of colon involved. Variability of symptoms reflects differences in the extent of disease and the intensity of inflammation.
What causes ulcerative colitis? - The cause of ulcerative colitis is not known, but heredity and an overactive immune response in the intestine may be contributing factors.
What are the symptoms of ulcerative colitis? - The symptoms vary according to the extent of the disease. The most common symptoms of ulcerative colitis are abdominal pain and bloody diarrhea.
What are the complications of ulcerative colitis? - Bleeding, the most common complication of ulcerative colitis, often causes iron deficiency anemia.
How is ulcerative colitis diagnosed? - Diagnosis of ulcerative colitis is suspected based on the symptoms that a patient is experiencing. The most important method of diagnosis is endoscopy.
What are the treatments for ulcerative colitis? - Treatment of ulcerative colitis depends on the location and severity of a patient's disease, the presence of complications.
What ulcerative colitis medications are available? - Medications for ulcerative colitis include 5-ASA Compounds, anticholinergic drugs, steroids, and immunosuppressive drugs.
What surgery treats ulcerative colitis? - Surgery for ulcerative colitis involves removal of the entire colon, regardless of whether all or only a portion of the colon is diseased.
Collagenous colitis and lymphocytic colitis - Collagenous colitis and lymphocytic colitis are chronic diseases in which certain kinds of white blood cells infiltrate the lining of the large intestine. 
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