Difference between revisions of "Lymphocytic colitis"

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#redirect [[Colon#Lymphocytic_colitis]]
'''Lymphocytic colitis''', abbreviated '''LC''', is a type of colitis has a characteristic clinical presentation and no apparent endoscopic changes.  It is a type of [[microscopic colitis]].
 
==General==
Presentation:
*Chronic diarrhea, non-bloody.<ref name=medscape180664>URL: [http://emedicine.medscape.com/article/180664-overview http://emedicine.medscape.com/article/180664-overview]. Accessed on: 31 May 2010.</ref>
 
*Lymphocytic colitis may be related to [[collagenous colitis]].
**It is hypothesized that these conditions may be the same pathology at different time points.<ref name=medscape180664/>
 
Notes:
*Clinical DDx includes [[irritable bowel syndrome]] - which has no or subtle histopathologic changes.
 
===Epidemiology===
*Age: a disease of adults - usually 50s.
*Sex:
**LC males ~= females,<ref name=medscape180664/>
**CC females:males = 20:1.<ref name=medscape180664/>
*Drugs are associated with LC and CC.
**NSAIDs - posulated association/weak association,
**SSRIs (used primarily for depression) - moderate association, dependent on specific drug.
*Associated with autoimmune disorders - [[celiac disease]], [[diabetes mellitus]], [[thyroid]] disorders and [[arthritis]].<ref name=pmid19109861>{{cite journal |author=Tysk C, Bohr J, Nyhlin N, Wickbom A, Eriksson S |title=Diagnosis and management of microscopic colitis |journal=World J. Gastroenterol. |volume=14 |issue=48 |pages=7280-8 |year=2008 |month=December |pmid=19109861 |doi= |url=http://www.wjgnet.com/1007-9327/14/7280.asp}}</ref>
*No increased risk of colorectal carcinoma.<ref name=pmid19109861/>
 
===Treatment===
*Sometimes just follow-up.
*Steroids - budesonide -- short-term treatment.<ref name=pmid19109861/>
 
==Gross==
*Endoscopic examination is normal.
**This is why it is called a ''[[microscopic colitis]]''.
 
==Microscopic==
Features:
*Lots of intraepithelial lymphocytes (>=20/100 lymphocytes/surface epithelial cells<ref name=pmid19109861>{{cite journal |author=Tysk C, Bohr J, Nyhlin N, Wickbom A, Eriksson S |title=Diagnosis and management of microscopic colitis |journal=World J. Gastroenterol. |volume=14 |issue=48 |pages=7280-8 |year=2008 |month=December |pmid=19109861 | PMC = 2778111 |doi= |url=http://www.wjgnet.com/1007-9327/14/7280.asp}}</ref>) and
*Lymphocytes in the lamina propria.
 
Significant negatives:<ref name=hopkins_cc_lc>[http://hopkins-gi.nts.jhu.edu/pages/latin/templates/index.cfm?pg=disease1&disease=29&organ=6&lang_id=1 http://hopkins-gi.nts.jhu.edu/pages/latin/templates/index.cfm?pg=disease1&disease=29&organ=6&lang_id=1]</ref>
*No neutrophils.
*No crypt distortion.
 
DDx:
*[[Infectious colitis]] - neutrophils present... not lymphocytes.
*[[Collagenous colitis]] - has a band of collagen below the epithelium.
 
Image:
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2778111/figure/F2/ LC (nih.gov)].<ref name=pmid19109861/>
 
==Sign out==
<pre>
ASCENDING COLON, BIOPSY:
- LYMPHOCYTIC COLITIS.
</pre>
 
===Micro===
The sections show colonic mucosa with abundant intraepithelial lymphocytes (>20 lymphocytes/100 surface epithelial cells). The glandular architecture is within normal limits. No thickened collagen band is apparent below the epithelium.
 
There are no granulomas. No neutrophilic cryptitis is apparent. The epithelium matures
appropriately to the surface.
 
==See also==
*[[Colon]].
*[[Collagenous colitis]].
 
==References==
{{Reflist|2}}


[[Category:Diagnosis]]
[[Category:Diagnosis]]
[[Category:Colon]]
[[Category:Gastrointestinal pathology]]

Revision as of 08:31, 31 July 2013

Lymphocytic colitis, abbreviated LC, is a type of colitis has a characteristic clinical presentation and no apparent endoscopic changes. It is a type of microscopic colitis.

General

Presentation:

  • Chronic diarrhea, non-bloody.[1]
  • Lymphocytic colitis may be related to collagenous colitis.
    • It is hypothesized that these conditions may be the same pathology at different time points.[1]

Notes:

Epidemiology

  • Age: a disease of adults - usually 50s.
  • Sex:
    • LC males ~= females,[1]
    • CC females:males = 20:1.[1]
  • Drugs are associated with LC and CC.
    • NSAIDs - posulated association/weak association,
    • SSRIs (used primarily for depression) - moderate association, dependent on specific drug.
  • Associated with autoimmune disorders - celiac disease, diabetes mellitus, thyroid disorders and arthritis.[2]
  • No increased risk of colorectal carcinoma.[2]

Treatment

  • Sometimes just follow-up.
  • Steroids - budesonide -- short-term treatment.[2]

Gross

Microscopic

Features:

  • Lots of intraepithelial lymphocytes (>=20/100 lymphocytes/surface epithelial cells[2]) and
  • Lymphocytes in the lamina propria.

Significant negatives:[3]

  • No neutrophils.
  • No crypt distortion.

DDx:

Image:

Sign out

ASCENDING COLON, BIOPSY:
- LYMPHOCYTIC COLITIS.

Micro

The sections show colonic mucosa with abundant intraepithelial lymphocytes (>20 lymphocytes/100 surface epithelial cells). The glandular architecture is within normal limits. No thickened collagen band is apparent below the epithelium.

There are no granulomas. No neutrophilic cryptitis is apparent. The epithelium matures appropriately to the surface.

See also

References

  1. ↑ 1.0 1.1 1.2 1.3 URL: http://emedicine.medscape.com/article/180664-overview. Accessed on: 31 May 2010.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 Tysk C, Bohr J, Nyhlin N, Wickbom A, Eriksson S (December 2008). "Diagnosis and management of microscopic colitis". World J. Gastroenterol. 14 (48): 7280-8. PMID 19109861. http://www.wjgnet.com/1007-9327/14/7280.asp. Cite error: Invalid <ref> tag; name "pmid19109861" defined multiple times with different content
  3. ↑ http://hopkins-gi.nts.jhu.edu/pages/latin/templates/index.cfm?pg=disease1&disease=29&organ=6&lang_id=1
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