Lymphocytic colitis

by Catherine Forse MD FRCPC
March 28, 2022

What is lymphocytic colitis?

Lymphocytic colitis is a non-cancerous condition caused by an increased number of immune cells within the mucosa that covers the inside surface of the colon.  This leads to inflammation and damage which prevents the colon from functioning normally.

What are the symptoms of lymphocytic colitis?

People with lymphocytic colitis can develop watery diarrhea that can last from weeks to years. Other possible symptoms can include abdominal pain, weight loss, and fatigue. Lymphocytic colitis belongs to a group of related conditions called microscopic colitis. This group includes collagenous colitis which shares many features with lymphocytic colitis.

What causes lymphocytic colitis?

Doctors still do not know what causes a person to develop lymphocytic colitis in the first place. However, one theory suggests that it may be an autoimmune condition where immune cells start to attack the cells in the colon. Another theory suggests that the condition may be a reaction to material in fecal matter.

How do pathologists make the diagnosis of lymphocytic colitis?

If your doctor suspects lymphocytic colitis based on your symptoms, they will perform a colonoscopy. A colonoscopy is a procedure where a small camera is used to see the inside of your colon. During this procedure, your doctor will take tissue samples called biopsies. Because lymphocytic colitis can happen in one part of the colon but not another, they will likely take multiple biopsies from the entire length of the colon. Your pathologist will then examine these biopsies under a microscope to determine whether lymphocytic colitis is present.

For most people with lymphocytic colitis, their colon will look entirely normal during the colonoscopy. That is because lymphocytic colitis is a ‘microscopic’ disease, and its features can only be seen when the tissue is examined under a microscope.

What does lymphocytic colitis look like under the microscope?

When the tissue is examined under the microscope an increased number of specialized immune cells called lymphocytes are seen within the mucosa on the inside of the colon. These lymphocytes are seen both within the glands and the lamina propria. Pathologists describe this change as intraepithelial lymphocytosis.

Over time, the increased lymphocytes damage the glands. This damage causes the cells to become smaller. Pathologists call this change atrophy. The smaller cells produce less mucin which prevents the colon from functioning normally.

While microscopic colitis can cause chronic inflammation in the colon, it is not the same as inflammatory bowel disease (IBD). IBD has many features which are not seen in microscopic colitis. For example, the size and shape of the crypts are abnormal. Pathologists call this change crypt distortion. To learn more about the features seen in IBD, read our article on chronic colitis.