Lymphocytic colitis

A 38-year-old woman with previously stable Crohn’s disease presents complaining of worsening diarrhoea. She is managed on a small dose of budesonide and mesalazine, and has had no symptoms up until 6 months ago. Now she opens her bowels many times per day with voluminous non-bloody diarrhoea.

Investigations

Hb	12.9 g/dl
WCC	5.0 x109/l
PLT	203 x109/l
Na+	139 mmol/l
K+	3.9 mmol/l
Cr	100 μmol/l
Colonic biopsies	lymphocytic infiltrate

Which of the following is the most likely diagnosis?

	Coeliac disease
	Tropical sprue
	Lymphocytic colitis	Your answer
	Ulcerative colitis
	Crohn’s reactivation  Lymphocytic colitis may occur in patients with other forms of GI pathology, including Crohn’s and Coeliac. Loperamide is often used as a first line therapy, with cholestyramine an alternative if there is bile salt malabsorption. Other alternatives include immune modulating agents such as azathioprine, although a response to therapy may take many months to appear. Approximately 20% of patients have a spontaneous remission without specific intervention.