Lymphocytic colitis very often responds to medical therapy, like budesonide or bismuth subsalicylate. Antidiarrhea agents like Imodium can also help. No specific diets are known to relieve symptoms, but in general, patients with lymphocytic colitis should avoid spicy foods and greasy and fatty foods, which are likely to make symptoms worse. Also, if you know that specific foods give you diarrhea, like milk and milk-containing foods, you should avoid them. You can read more about ulcerative colitis and diet in Everyday Health’s Ulcerative Colitis Center. Q2. My daughter has extraintestinal manifestations of ulcerative colitis. Though the colitis is under control, she is on prednisone for the inflammation outside of the colon. They want her to transition to Imuran (azathioprine), but a friend of hers died recently from Remicade (infliximab)/Imuran therapy-induced lymphoma, and she is very concerned about the cancer risk. Do you have any statistics? Her doctor says 1 in 1,000 reported cases of lymphoma with Imuran, and that is an unacceptable number. Do you have any better information? I am glad to hear your daughter’s colitis is under control, but she will not be able to stay on prednisone for long due to intolerable side effects. Often, drugs like azathioprine (Imuran) and 6-mercaptopurine are able to maintain remission while the prednisone is tapered. Azathioprine side effects include leucopenia(lowering of the white blood cell count), pancreatitis and allergy– each of which is rare and reversible. Exceedingly rare is the complication of lymphoma. One in 1,000 seems about right to me for the risk of lymphoma in Crohn’s disease, and azathioprine may increase that risk to about 1.5 in 1,000. Adding infliximab (Remicade) to azathioprine increases the risk of lymphoma dramatically, and because of the risk, many physicians are using azathioprine or infliximab as single therapy, not in combination. So, while there is a small increased risk of developing lymphoma from azathioprine, the benefits are great if your daughter can be successfully tapered from prednisone. Q3. My uncle was just diagnosed with collagenous colitis, and the family was curious about what kind of diet he should be following. His doctor has not given him a whole lot of information. Thank you for your help in advance. Patients with collagenous colitis have diarrhea, and should avoid foods that are more likely to cause diarrhea. Products that are high in lactose (milk, cottage cheese, cream cheese, sour cream, ice cream) should be avoided. Hard cheeses and yogurt usually are well-tolerated since the lactose is broken down already by the time it reaches the grocery store. Cruciferous vegetables (broccoli, cauliflower, cabbage) and legumes (beans, chickpeas) also should be avoided if possible. Very spicy foods also can cause diarrhea. Q4. I was diagnosed with lymphocytic colitis about a month ago. I am only 28 years old. I can’t seem to find much information. My doctor told me there is no known cause for this. He is treating me with Entocort. He did not give me any diet guidelines to go by. Can you give me more information on this condition and any helpful diet tips? Lymphocytic colitis is a diarrheal illness characterized by a near-normal colonoscopy and biopsies that show an excess of lymphocytes (a type of white blood cell that helps fight infection) on the bowel wall. Your doctor is right – the cause really is unknown. The best therapies are Entocort (budesonide) and Pepto-Bismol (bismuth subsalicylate). Unfortunately, there are no specific diets that are known to help, but extremely spicy foods can make the diarrhea and inflammation worse. It sounds like you are on the right therapy, which you may not need for a long period of time. The disease is short-lived in some patients. Q5. Is lymphocytic colitis part of the Crohn’s family of ailments, or is it more closely related to ulcerative colitis? Lymphocytic colitis is an inflammatory bowel disease, but it is neither ulcerative colitis nor Crohn’s disease. There are features of the disease that suggest it is related to both. For example, it affects the colon, like ulcerative colitis, but it responds to the steroid budesonide (Entocort), like Crohn’s disease. Therefore, I think you have to consider lymphocytic colitis a separate entity from ulcerative colitis and Crohn’s disease. Learn more in the Everyday Health Ulcerative Colitis Center.
