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Lymphocytic and collagenous colitis (microscopic colitis)

INTRODUCTION

Microscopic colitis is characterized by chronic watery (secretory) diarrhea without bleeding. It usually occurs in middle-aged patients but can affect children. The colon appears normal by colonoscopy or barium enema. The diagnosis is established by biopsy of the colonic mucosa which reveals colitis, but not mucosal ulcerations.

DEFINITION

Two different types of microscopic colitis have been generally recognized [1]:

  • Lymphocytic colitis
  • Collagenous colitis without lymphocytic infiltration of the surface epithelium

A mixed form, characterized by both thickening of the collagen plate and increased number of intraepithelial lymphocytes, has also been described. However, thickening of the collagen band without evidence of colitis may be seen in a variety of conditions such as in the mucosa adjacent to an adenoma, in ischemic colitis, and chronic trauma.

Collagenous colitis was first described in 1976 [2]; since that time, multiple cases have been reported [1,3-9]. It is characterized by a thickened subepithelial collagenous band in the colonic mucosa that varies in thickness from 7 to as much as 100 µm (normal 1 to 7 µm more prominent in the rectum) (picture 1A-B) [5,9,10]. In comparison, lymphocytic colitis is characterized by a subepithelial lymphocytic infiltrate rather excess collagen in the colonic mucosa (picture 2) [1,8,11,12].
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