Lymphocytic Colitis: Symptoms & Treatment Options (2023)


Lymphocytic Colitis: Symptoms & Treatment Options (1)

What is lymphocytic colitis?

Lymphocytic colitis is a type of microscopic colitis, which is a type of inflammatory bowel disease. Inflammatory bowel diseases are chronic diseases that cause ongoing inflammation in your intestines. Colitis means inflammation of the large intestine (colon). Microscopic colitis is colitis that can only be seen under a microscope. Scientists recognize the different types of microscopic colitis by analyzing the cells in your intestinal lining.

Lymphocytic colitis is characterized by an abnormally high density of lymphocytes in your intestinal lining. Lymphocytes are a type of white blood cell. When they show up in large numbers, it usually means your immune system has been activated to fight off an infection. That’s what inflammation usually means, too. With lymphocytic colitis, there’s no infection, but your body acts as though there is.

Is lymphocytic colitis an autoimmune disease?

Most scientists believe so. They believe all inflammatory bowel diseases are. Autoimmune diseases cause chronic inflammation in different parts of your body in the absence of any infection. They happen when your immune system attacks your own body’s cells, apparently mistaking those cells for infectious agents. Autoimmune diseases may be partly determined by genes, and partly by environmental factors.

How serious is lymphocytic colitis?

Lymphocytic colitis causes chronic inflammation in your colon, which is the end part of your GI (gastrointestinal) tract. This is the last leg of the journey your food takes through your digestive system, where food waste is gradually condensed into poop. Inflammation in your colon can interfere with this process. With lymphocytic colitis, the most typical result is chronic, watery diarrhea, between five and 10 times a day.

Frequent, urgent diarrhea can certainly affect your quality of life. Fortunately, most people only have periodic symptoms. While lymphocytic colitis is a lifelong condition, it can go into remission for long periods. When it does flare up, most people find it manageable with medication and diet. It’s not likely to cause serious or permanent damage to your colon, as other types of inflammatory bowel disease can.

(Video) Microscopic Colitis (Lymphocytic & Collagenous Colitis) - An Underdiagnosed Form of IBD

Who does lymphocytic colitis affect?

It can affect anyone, but it becomes more common with age. It rarely affects children and most people are diagnosed after the age of 65. It’s about twice as common in women or people assigned female at birth (AFAB) as in men or people assigned male at birth (AMAB). It’s also more common in people who smoke tobacco, and these people tend to develop lymphocytic colitis earlier than others, by an average of 10 years.

Up to 40% of people with lymphocytic colitis also have another autoimmune disease, such as:

  • Rheumatoid arthritis.
  • Celiac disease.
  • Type 1 diabetes.
  • Thyroid disease.

Symptoms and Causes

What are the symptoms of lymphocytic colitis?

Lymphocytic colitis changes the cellular composition of your large intestinal lining (mucosa). This causes frequent, watery diarrhea — typically between five and 10 times a day. About half of people report cramping and abdominal pain with it. Severe diarrhea can also lead to fecal incontinence — difficulty holding poop in — and it may cause dehydration, unintended weight loss or fatigue as side effects.

Some people also experience inflammatory symptoms in other parts of their bodies. This is typical with chronic inflammatory diseases. In fact, it’s fairly common for people to have more than one autoimmune disease diagnosis at a time. Common secondary symptoms in people with lymphocytic colitis include joint pain and stiffness (arthritis), eye inflammation (uveitis) and skin rashes (psoriasis).

What causes lymphocytic colitis?

Chronic inflammation in your colon causes cellular changes that lead to chronic diarrhea. But scientists aren’t sure why chronic inflammation develops in the absence of infection. Most believe that it involves a combination of factors. Some people may be genetically predisposed to develop it, like other autoimmune diseases. But in addition to that, some environmental stress factor probably triggers it.

(Video) Microscopic Colitis: Diagnosis and Treatment

Possible triggers include:

  • A previous bacterial or viral infection in your gut.
  • Food or pollen allergies affecting your gut.
  • Frequent use of certain medications, including aspirin and ibuprofen.
  • Smoking.

Diagnosis and Tests

How is lymphocytic colitis diagnosed?

By definition, lymphocytic colitis can only be diagnosed from a tissue sample examined under a microscope. A gastroenterologist will take the tissue sample during a colonoscopy. In this procedure, they’ll examine the inside of your colon with a flexible instrument called a colonoscope. They’ll take multiple tissue samples (biopsy) through the colonoscope and send them to a lab for analysis.

If you have lymphocytic colitis, your colonoscopy will appear normal, but your biopsies will reveal inflammation with a high density of lymphocytes. If you have another condition, it’ll probably be visible during your colonoscopy. Your gastroenterologist will probably try to rule out other possible causes before testing you for microscopic colitis. They may order blood tests or poop tests first.

Management and Treatment

How is lymphocytic colitis treated?

Some people improve with minimal treatment, and others require prescription medication. It may take some trial and error to determine what works best for you. Your doctor will make suggestions based on how severe your symptoms are and how you respond to conservative treatment. They may begin by suggesting changes to your existing medications and diet before prescribing new medications.

(Video) Microscopic colitis: A common, yet often overlooked, cause of chronic diarrhea

Medications may include:

  • Over-the-counter (OTC) antidiarrheal drugs, such as loperamide or diphenoxylate.
  • Bismuth Subsalicylate (Pepto Bismol®) several times a day for a few weeks.
  • Budesonide, a corticosteroid that’s absorbed in your colon, for inflammation.
  • Bile acid sequestrants (colesevelam, colestipol), which can treat certain types of diarrhea.

Outlook / Prognosis

Is lymphocytic colitis curable?

Strictly speaking, it’s not curable because it can always come back. However, it can go into remission, which means the diarrhea and inflammation go away. Many people see their symptoms resolve almost completely over the course of a few years. In some people, remission appears to happen spontaneously. In others, it happens after figuring out the treatment, diet and lifestyle changes that work for them.

Living With

What type of diet is best for lymphocytic colitis?

Your doctor may recommend that you avoid foods that commonly trigger diarrhea. You can test these foods individually if you’d like to see if they trigger yours. You may also have particular food sensitivities that aren’t on the list. Take notice of how your symptoms change when you add or remove certain foods. (An elimination diet, such as the Low-FODMAP diet, can help you isolate your food triggers.)

Common foods to avoid include:

(Video) A Microscopic Colitis Disease Activity Index to score the severity and compare treatments

  • Alcohol.
  • Caffeine.
  • Artificial sweeteners.
  • Dairy products.
  • Gluten.
  • High-fiber foods.
  • High-fat foods.

For a severe flare-up of diarrhea, your doctor may recommend you fall back on the BRAT diet. BRAT stands for bananas, rice, apple sauce and toast. Basically, it means bland, easy-to-digest foods. This isn’t a nutritious long-term diet, but it’ll do for a few days. If you need a less restricted diet to manage your symptoms for longer periods, try a soft diet. It’s low-fat and low-fiber, but more varied and nutritious.

Frequently Asked Questions

What's the difference between lymphocytic colitis and collagenous colitis?

Collagenous colitis is the other main recognized type of microscopic colitis. Collagenous colitis is characterized by abnormally thick bands of connective tissue in your intestinal lining. Aside from their microscopic differences, collagenous colitis and lymphocytic colitis cause the same symptoms and are treated in the same way. Some believe they might actually be different stages of the same disease.

A note from Cleveland Clinic

Lymphocytic colitis is a chronic disease that develops relatively suddenly and late in life. It’s also somewhat obscure and not as well understood as other inflammatory bowel diseases. This can be a bewildering diagnosis to receive, especially if you’ve never heard of it before. But the good news is that it’s usually a manageable disease. With treatment and self-care, it can even go into remission.


What is the food to avoid if you have lymphocytic colitis? ›

No specific diets are known to relieve symptoms, but in general, patients with lymphocytic colitis should avoid spicy foods and greasy and fatty foods, which are likely to make symptoms worse. Also, if you know that specific foods give you diarrhea, like milk and milk-containing foods, you should avoid them.

What medications are used to treat lymphocytic colitis? ›

What treatments have been tried for lymphocytic colitis? Budesonide, mesalazine with or without cholestyramine, beclometasone dipropionate and bismuth subsalicylate (i.e. Pepto-Bismol®) have been tried as treatment for lymphocytic colitis.

What aggravates lymphocytic colitis? ›

Bacterial and viral infections, certain medicines, or certain foods may trigger lymphocytic colitis in some people. Symptoms of lymphocytic colitis include watery diarrhea, belly pain, and fatigue.

How do you treat lymphocytic colitis naturally? ›

Lifestyle and home remedies
  1. Drink plenty of fluids. Water is best, but fluids with added sodium and potassium (electrolytes) may help as well. ...
  2. Choose soft, easy-to-digest foods. These include applesauce, bananas, melons and rice. ...
  3. Eat several small meals rather than a few large meals. ...
  4. Avoid irritating foods.
Jan 20, 2021

How do you get rid of lymphocytic colitis? ›

Symptomatic treatment includes:
  1. Eliminating caffeine or foods containing lactose, as those foods may aggravate diarrhea.
  2. Maintaining a low-fat diet, especially if steatorrhea (excess fat in stool) is present.
  3. Taking cholestyramine, a medication that reduces cholesterol levels in the blood.
  4. Taking antidiarrheal medications.

Why do I have lymphocytic colitis? ›

The underlying cause of Lymphocytic colitis is currently unknown; however, scientists suspect that autoimmune conditions, medications, infections, genetic factors, and/or bile acid malabsorption may contribute to the development of the condition.

How long can you take budesonide for lymphocytic colitis? ›

Induction of clinical remission

[13] Thus, several studies support the use of budesonide for the induction of remission in patients with CC, usually involving 6-9 mg of budesonide daily for 6-8 weeks duration.

Can lymphocytic colitis disappear? ›

There is no cure, but treatment can manage the symptoms. Treatment options depend on the severity of the symptoms, but may include: Watchful waiting – some patients with mild symptoms improve without any treatment, for reasons unknown.

What is the latest treatment for colitis? ›

Ustekinumab is FDA-approved to treat both UC and CD. Risankizumab was FDA-approved in June 2022 to treat moderate to severe CD; clinical trials to assess its utility in UC are ongoing. Anti-Integrin: These medications block white blood cells that cause inflammation from entering the GI tract.

What does lymphocytic colitis feel like? ›

The main symptom of collagenous colitis and lymphocytic colitis is chronic, watery diarrhea, as often as five to 10 watery bowel movements per day. More than half of patients cannot pinpoint when their symptoms began. The diarrhea is usually accompanied by cramps and abdominal pain.

What happens if lymphocytic colitis goes untreated? ›

Untreated lymphocytic colitis may result in repeated inflammation that waxes and wanes. This inflammation may in turn result in the formation of an inflammatory mass lesion. More studies on the natural history of lymphocytic colitis are needed in order to determine its outcome, prognosis and progression, if any.

How long does it take to recover from lymphocytic colitis? ›

Four out of five can expect to be fully recovered within three years, with some even recovering without treatment. However, for those who experience persistent or recurrent diarrhea, long term budesonide may be necessary.

Can probiotics help lymphocytic colitis? ›

17.4 Collagenous Colitis and Lymphocytic Colitis

In an open trial, the probiotic E. coli Nissle significantly decreased the frequency of stools per day from 7.6 ± 4.8 to 3.7 ± 5.8 (p = 0.034) [158], and a randomized, placebo-controlled, double blind, multicenter study showed that a mix of probiotic bacteria (L.

How do you get lymphocytic? ›

A family history of chronic lymphocytic leukemia or other blood and bone marrow cancers may increase your risk. Exposure to chemicals. Certain herbicides and insecticides, including Agent Orange used during the Vietnam War, have been linked to an increased risk of chronic lymphocytic leukemia.

What is the most common side effect of budesonide? ›

runny nose, sneezing, coughing. nausea.

Who should not use budesonide? ›

If your or your child's symptoms do not improve within one to two weeks, or if they become worse, check with your doctor. This medicine may weaken your immune system. Avoid being around people who are sick or who have infections such as chickenpox or measles.

Why can't you take budesonide long term? ›

Using too much of this medicine or using it for a long time may increase your risk of having adrenal gland problems. Talk to your doctor if you have darkening of the skin, diarrhea, dizziness, fainting, loss of appetite, mental depression, nausea, skin rash, unusual tiredness or weakness, or vomiting.

Can stress cause lymphocytic colitis? ›

Chronic stress promotes colitis by disturbing the gut microbiota and triggering immune system response.

Does Pepto Bismol help with lymphocytic colitis? ›

In a case series of patients treated with Pepto-Bismol (eight tablets/day for eight weeks), dramatic clinical improvement was noted. Colectomy in a handful of patients resulted in diarrhea and one case of enteropathic colitis.

What is the best anti inflammatory for colitis? ›

Anti-inflammatory drugs are often the first step in the treatment of ulcerative colitis, typically for mild to moderate disease. Anti-inflammatories include aminosalicylates, such as mesalamine (Delzicol, Rowasa, others), balsalazide (Colazal) and olsalazine (Dipentum).

What is the best drug for colitis? ›

Aminosalicylates. Aminosalicylates, also known as 5-ASAs, are medicines that help to reduce inflammation. This in turn allows damaged tissue to heal. They're usually the first treatment option for mild or moderate ulcerative colitis.

What foods soothe inflamed intestines? ›

Suggestions for first foods after a flare include:
  • Diluted juices.
  • Applesauce.
  • Canned fruit.
  • Oatmeal.
  • Plain chicken, turkey or fish.
  • Cooked eggs or egg substitutes.
  • Mashed potatoes, rice or noodles.
  • Bread – sourdough or white.

What probiotic is best for lymphocytic colitis? ›

New research suggests that use of a probiotic strain Lactobacillus reuteri may suppress intestinal inflammation. This research seems interesting at first glance, because until guidelines were recently changed, probiotics were generally recommended as part of a medical treatment regimen for microscopic colitis.

Can lymphocytic colitis come on suddenly? ›

Symptoms may start suddenly or begin gradually and become worse over time. Symptoms may vary in severity. For example, many people with microscopic colitis have four to nine bowel movements a day, but some people with microscopic colitis may have more than 10 bowel movements a day.

Is lymphocytic colitis an autoimmune disease? ›

A high number of associated autoimmune conditions was noted for both collagenous colitis and lymphocytic colitis (table 4). Seven patients with lymphocytic colitis and three patients with collagenous colitis had a longstanding diagnosis of coeliac disease.

Can lymphocytic colitis turn into ulcerative colitis? ›

The association between microscopic colitis and inflammatory bowel disease is weak and unclear. Lymphocytic colitis progressing to ulcerative colitis has been previously reported; however there is limited data on ulcerative colitis evolving into microscopic (lymphocytic or collagenous) colitis.

How do I know if my colitis is getting worse? ›

You have more mucus, pus, and blood in your stool. Pain in your belly gets worse and more widespread, especially up the left side. It can also affect your desire to eat and cause you to lose weight. And some of those symptoms may just be signs of a stronger flare-up.

How do you stop a microscopic colitis flare up? ›

Your doctor may suggest:
  1. Eliminating common triggers. Some of the most common trigger foods for microscopic colitis include: ...
  2. Low fat and low fiber. To manage flare-ups, some healthcare providers recommend a gastrointestinal soft diet, which is made up of low fat and low fiber foods. ...
  3. Elimination diet. ...
  4. Anti-inflammatory diet.
Apr 24, 2022

Which probiotic is best for microscopic colitis? ›

Probiotics for Microscopic colitis

The combination of 2 probiotic strains (Lactobacillus acidophilus LA-5 and Bifidobacterium animalis subsp. lactis BB-12) we were shown to improve symptoms of this gut condition.

Does lymphocytic colitis ever go away? ›

There is no cure, but treatment can manage the symptoms. Treatment options depend on the severity of the symptoms, but may include: Watchful waiting – some patients with mild symptoms improve without any treatment, for reasons unknown.

What foods can irritate colitis? ›

What foods trigger colitis? There are several foods that may trigger your symptoms, including fatty and greasy foods, spicy foods, high-sugar foods, caffeine, alcohol, and carbonated beverages.

What foods get rid of colitis? ›

The following foods may be suitable for a person who has just had a flare-up of Crohn's disease or ulcerative colitis:
  • diluted juices.
  • applesauce.
  • canned fruit.
  • oatmeal.
  • plain chicken, turkey, or fish.
  • cooked eggs or egg substitutes.
  • mashed potatoes, white rice, or noodles.
  • sourdough or white bread.
Apr 15, 2021

What drinks soothe colitis? ›

5 Gut-Soothing Teas for People With Ulcerative Colitis
  • Turmeric and Ginger Tea.
  • After-Dinner Belly-Soothing Tea.
  • Calendula Tea.
  • Slippery Elm Tea.
  • Green Ginger Mint Tea.
May 26, 2021

Is oatmeal OK with colitis? ›

Instant oatmeal makes a quick and hearty meal or snack. According to UC San Diego Health, this version of the grain is generally easy for people with ulcerative colitis to digest.

What is the best fruit for colitis? ›

Ripe bananas and canned fruits: Although dietitians generally recommend avoiding raw fruits during a flare, very ripe, soft bananas are often well tolerated. Bananas are also a good source of carbohydrates, which, along with protein and fats, provide energy.

Is yogurt good for colitis? ›

Yogurt is a great way to include probiotics in a person's diet. Some people may find that probiotics can help ease symptoms of ulcerative colitis because of the healthy bacteria they provide to a person's gut.

Is Pasta Good for colitis? ›

If you suffer from ulcerative colitis, you may just want to avoid anything which is rich in fibre. Rather than opting for wheat bread, pasta and cereals opt for the ones that are made of flour. Whole grains like brown rice and quinoa are also a strict no.

What is the best probiotic for colitis? ›

Saccharomyces boulardii and ulcerative colitis. The study's 'preliminary results suggest that S. boulardii can be effective in the treatment of ulcerative colitis'7.


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