Ulcerative colitis is a common inflammatory bowel disease (IBD) that often starts in early adulthood. Lymphocytic colitis is a rare IBD that mostly affects older adults. It’s only detectable under a microscope.

Ulcerative colitis (UC) and lymphocytic colitis (LC) are both types of IBD that cause inflammation in the large intestine, called the colon. Though there are similarities between the two, the conditions are distinct and unrelated.

The primary difference between the conditions is that doctors can see UC during a colonoscopy but can only observe LC inflammation under a microscope.

Keep reading to learn more about how LC differs from UC in its causes, symptoms, diagnosis, treatment, and outlook.

LC is a type of microscopic colitis. It causes inflammation in the colon’s inner lining that can only be seen under a microscope.

LC is a chronic disease. It falls under the umbrella term of inflammatory bowel disease (IBD). Experts think irregular reactions of the body’s immune system may cause LC.

Types of microscopic colitis

There are two types of microscopic colitis. Each type results in different changes in the colon’s tissue, but they have the same symptoms and treatment:

  • Lymphocytic colitis: The colon lining contains more white blood cells than typical.
  • Collagenous colitis: The layer of collagen under the colon lining is thicker than typical.
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Symptoms of LC and UC vary from person to person and may come and go.

The main symptom of LC is frequent, watery diarrhea that does not contain blood.

The main symptoms of UC are watery diarrhea and sudden urges to have a bowel movement. The stool may have blood, pus, or mucus.

Here’s a breakdown of the differences in symptoms between the two conditions:

SymptomsLymphocytic colitis (LC)Ulcerative colitis (UC)
watery diarrheaXX
abdominal painXX
bloody diarrhea with mucusX
fatigueXX
weight lossXX
mouth soresX
feverX
joint painX
anemiaX

Like UC, experts are not sure of the exact cause of LC. Genetics may play a role in both conditions, as may having other immune disorders.

Researchers are exploring other possible explanations, including:

  • changes in your gut bacteria
  • excess bile acid entering the colon
  • infections

Out of 100,000 people, experts estimate that 2–19 people will develop LC each year.

Anyone can get LC at any age, but certain factors increase your risk, including:

  • being over age 60 years
  • being female
  • smoking
  • taking certain medications, including:
    • nonsteroidal anti-inflammatory drugs (NSAIDs)
    • selective serotonin reuptake inhibitors (SSRIs)
    • proton pump inhibitors (PPIs)
  • having another disorder related to the immune system, such as:
    • celiac disease
    • psoriasis
    • rheumatoid arthritis
    • type 1 diabetes

On the other hand, people tend to receive a UC diagnosis in early adulthood.

Distinguishing between UC and LC begins with a colonoscopy.

In this procedure, a doctor inserts a camera at the end of a flexible tube into your colon. Signs of UC will show up on a colonoscopy.

During the colonoscopy, a doctor can take a biopsy of the colon. A biopsy involves removing a small tissue sample from the colon lining and examining it under a microscope. A biopsy can help confirm a diagnosis of LC.

Your doctor may also take a sample of your stool to look for parasites or other infections that could be causing your symptoms. They may take a blood sample to run additional tests to rule out other inflammatory conditions.

Like UC, treatment for LC aims to reduce inflammation and the frequency of flares.

The first step is to stop anything triggering the disease, including medications or smoking.

Your doctor may prescribe antidiarrheal agents, such as loperamide, to help manage your symptoms.

If you continue to have watery diarrhea, your doctor may also prescribe additional medications, like:

  • budesonide
  • cholestyramine
  • bismuth subsalicylate

Diet

You may be able to manage your symptoms by making changes to your diet, especially by avoiding or limiting your intake of certain foods and beverages.

Food and beverages to avoid or limit include:

  • alcohol
  • caffeine
  • artificial sweeteners
  • milk and milk products if you’re lactose intolerant
  • foods high in fiber, such as:
    • beans
    • raw fruits and vegetables
    • nuts and seeds
    • whole wheat bread or rice

Be sure to drink plenty of water during episodes of diarrhea to avoid dehydration.

You may also consider keeping a food journal to help determine which foods trigger your symptoms.

Like UC, LC is a lifelong, chronic condition. However, people with LC experience long periods of remission where they have no symptoms. Many people with LC enter remission within 6–8 weeks of treatment.

But unlike UC, there are not any known complications of LC. For example, LC does not increase your risk of developing colon cancer.

Here are answers to frequently asked questions about lymphocytic colitis:

How serious is lymphocytic colitis?

There aren’t any known complications of LC. It’s not likely to cause serious or permanent damage to your colon. Still, its symptoms can negatively affect your quality of life.

Can lymphocytic colitis turn into ulcerative colitis?

Researchers aren’t currently sure whether LC can turn into UC.

A 2020 study found that people with microscopic colitis were 17 times more likely to develop some other form of IBD, such as UC, than people without the condition.

However, researchers didn’t control for lifestyle and dietary factors, which could have affected the associations observed during the study.

Is lymphocytic colitis an autoimmune disorder?

Some experts suspect LC is an autoimmune disorder that occurs when your immune system launches an attack on your own body. However, research has yet to identify the exact cause of LC and other types of IBD.

UC and LC are both inflammatory bowel diseases that cause inflammation in the large intestine. But there are key differences.

LC is more common among adults ages 60 and older, while UC diagnoses tend to occur in early adulthood.

Doctors can detect inflammation from UC during a colonoscopy. They can only detect LC inflammation under a microscope.

Researchers are still trying to understand whether the two conditions are linked.