Lymphocytic colitis: a distinct clinical entity? A clinicopathological confrontation of lymphocytic and collagenous colitis

Abstract

Background and aims-It is not known whether lymphocytic colitis and collagenous colitis represent diVerent clinical entities or constitute part of a spectrum of disease. Methods-Detailed clinical features and histological findings were compared in a large series of patients with confirmed lymphocytic and collagenous colitis. Results-Histological diagnosis was confirmed in 96 patients with collagenous colitis and 80 with lymphocytic colitis. Twenty eight per cent of patients with collagenous colitis and 26% of patients with lymphocytic colitis had overlapping but less pronounced histological features. Both groups were equal in terms of age, use of aspirin and non-steroidal antiinflammatory drugs, associated autoimmune conditions, arthritis, diarrhoea, and abdominal pain. The male:female ratio was 27:73 for collagenous colitis and 45:55 for lymphocytic colitis (p=0.013). Twenty five per cent of patients with collagenous colitis compared with 14% of patients with lymphocytic colitis were active smokers; only 8.3% of patients with collagenous colitis had stopped smoking compared with 23% of patients with lymphocytic colitis (p=0.013). Drug induced disease was suspected for ticlopidine (two collagenous colitis, four lymphocytic colitis) and flutamide (four lymphocytic colitis). Mean duration of symptoms before diagnosis was two months for lymphocytic colitis and four months for collagenous colitis. Overall prognosis was generally mild; 84% of patients with lymphocytic colitis and 74% of patients with collagenous colitis reported resolution or significant improvement (p=0.033). Conclusions-Collagenousand lymphocytic colitis are similar but not identical. Patients with lymphocytic colitis present somewhat earlier and are less likely to be active smokers. Symptoms are milder and more likely to disappear in lymphocytic colitis. Ticlopidine and flutamide should be added to the list of drugs inducing colitis. (Gut 1999;45:375-381)

Prevalence of microscopic colitis in patients with diarrhea of unknown etiology in Turkey

“…Fifteen patients (11.5%) had microscopic colitis (12 lymphocytic colitis and 3 collagenous colitis; 9%, 2.5%, respectively) ( Figure 1A and B). Seven of the lymphocytic colitis patients were female, mean age was 45 ± 11.6 (27-63), mean duration of diarrhea was 22 mo (4-96) and mean number of daily defecation was 5 (3)(4)(5)(6)(7)(8)(9). Criteria of lymphocytic colitis were present in specimens obtained from all segments of the colon of these patients.…”

“…In the studies of Lazenby et al and Baert et al, the mean IEL per 100 intercryptal epithelial cells was 34.7 and 29.4, respectively [5,8] . In the current study, the mean IEL per 100 intercryptal epithelial cells was 28.2.…”

“…Over 20 IEL per 100 intercryptal epithelial cells (normal < 1-5/100) were deemed necessary for the diagnosis of lymphocytic colitis [7,8,12] (Table 2). For collagenous colitis subepithelial collagen band thickness was measured by ocular micrometer in Masson's Trichrome stained specimens.…”

“…For collagenous colitis subepithelial collagen band thickness was measured by ocular micrometer in Masson's Trichrome stained specimens. Thickness over 10 µm was required for the diagnosis [7,8,12] (Table 2).…”

“…Clinical and histological characteristics of microscopic colitis have been well established [4][5][6][7][8] . However, limited data is available regarding the prevalence, pathogenesis and progress of the disease and its treatment.…”