Colitis: Microscopic Causes of Collagenous and lymphocytic colitis

Home of Kyle J. Norton for The Better of Living & Living Health Colitis is defined as a condition of inflammation of the large intestine, including the colon, caecum and rectum.

I. Types of Colitis
According to the study by Catholic University of the Sacred Heart, types of colitis include
microscopic colitis, ischemic colitis, segmental colitis associated with diverticula, radiation colitis, diversion colitis, eosinophilic colitis and Behcet’s colitis(a).

II. Causes 
A.1.2. Microscopic colitis (Collagenous and lymphocytic colitis)
Microscopic colitis may be defined as a clinical syndrome, of unknown etiology, consisting of chronic watery diarrhea, with no alterations in the large bowel at the endoscopic and radiologic evaluation. According to the study by University of Sacred Heart, the epidemiological impact of this disease has become increasingly clear in the last years, with most data coming from Western countries. Microscopic colitis includes two histological subtypes [collagenous colitis (CC) and lymphocytic colitis (LC)] with no differences in clinical presentation and management(10).
Other researchers indicated that Collagenous and lymphocytic colitis are well-described conditions causing chronic watery diarrhoea. A peak incidence from 60 to 70 years of age with a female predominance mainly in collagenous colitis is observed. Both conditions are characterised by a (near) normal colonoscopy, but with specific histologic findings on colonic biopsies. Histopathologically, both conditions are characterised by distinct epithelial abnormalities and a dense lymphoplasmocytic infiltrate. Distinct features consist of a characteristic collagen band deposition in the subepithelial layer in collagenous colitis and a markedly increased number of intra-epithelial lymphocytes in lymphocytic colitis(10a)
a. Collagenous colitis (CC)
Collagenous colitis (CC), a form of microscopic colitis, is characterized by a thick subepithelial collagen layer in the colon in the presence of chronic nonbloody watery diarrhoea and macroscopically normal-appearing colonic mucosa. According to the Hepatology and Nutrition, The Hospital for Sick Children, typically affecting elderly adults, CC is rare in children with only 12 cases previously reported in the literature, but we report a case of a 4-year-old girl with CC associated with eosinophilic gastritis(10b).

b. Lymphocytic colitis
In the study to evaluate the biopsy specimens from the terminal ileum of 32 patients with the histopathological diagnosis of lymphocytic colitis or collagenous colitis and 11 control individuals  for the presence or absence of ileal mucosal abnormalities and for the number of intraepithelial lymphocytes, assessed by immunohistochemical stains for the pan T-cell marker, CD3, showed that the mean CD3 counts in patients with lymphocytic/collagenous colitis were significantly higher than those in the control group. Seven of 14 patients with collagenous colitis and 14 of 18 patients with lymphocytic colitis revealed an increase in intraepithelial T lymphocytes when compared with the control group (P =.001). Other notable changes included ileal villous atrophy in one case of lymphocytic colitis and in three cases of collagenous colitis and epithelial damage with thickened subepithelial collagen in two cases of collagenous colitis(10c).

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Sources
(a) http://www.ncbi.nlm.nih.gov/pubmed/23208963
(10) http://www.ncbi.nlm.nih.gov/pubmed/23180940
(10a) http://www.ncbi.nlm.nih.gov/pubmed/20203510
(10b) http://www.ncbi.nlm.nih.gov/pubmed/17718794
(10c) http://www.ncbi.nlm.nih.gov/pubmed/12591963 http://medicaladvisorjournals.blogspot.com