Collagenous Colitis and Lymphocytic Colitis in Grand Rapids, MI

Collagenous colitis and lymphocytic colitis are forms of microscopic colitis, a type of inflammatory bowel disease (IBD) that affects the large intestine (colon). They are called “microscopic” because the colon often looks normal during colonoscopy, and diagnosis requires examining small tissue samples (biopsies) under a microscope.

In Grand Rapids, Michigan, these conditions are typically diagnosed and managed by gastroenterologists at major centers such as Corewell Health (formerly Spectrum Health), Trinity Health Grand Rapids, Metro Health – University of Michigan Health, and Mercy Health.

What Are Collagenous and Lymphocytic Colitis?

Both conditions cause chronic, watery, non-bloody diarrhea, but they differ in what doctors see under the microscope:

Collagenous Colitis

  • The inner lining of the colon (the epithelium) looks normal and is not visibly inflamed.
  • Just beneath this lining is a layer of collagen, a strong, fibrous protein.
  • In collagenous colitis, this collagen layer becomes abnormally thickened and inflamed.
  • Because the surface lining is intact, the diarrhea does not contain blood or pus.

Lymphocytic Colitis

  • Symptoms are usually identical to collagenous colitis.
  • The collagen layer is not thickened.
  • Instead, there is a build-up of immune cells called lymphocytes within the epithelium.
  • The outer lining of the colon remains undamaged, so the diarrhea is also non-bloody and free of pus.

Some researchers believe collagenous colitis and lymphocytic colitis may be different stages of the same disease, but this theory is still unproven.

Who Is Affected?

  • Most people are diagnosed between ages 60 and 80.
  • Both men and women can be affected, though some studies suggest a slight female predominance.
  • In West Michigan and the Grand Rapids area, older adults seen in primary care or GI clinics are the group most commonly diagnosed.

Because these conditions can be subtle and mimic other digestive problems, they may be underdiagnosed, especially in community settings.

Symptoms of Microscopic Colitis

Collagenous colitis and lymphocytic colitis share similar symptoms. Common signs include:

  • Watery diarrhea that does not contain blood or pus
    • May be chronic (lasting more than four weeks)
    • May come and go in flares
  • Urgency to have a bowel movement
  • Bowel incontinence (leakage of stool)
  • Abdominal cramps or pain
  • Abdominal bloating and discomfort
  • Nausea
  • Fatigue and low energy
  • Unintentional weight loss (in more severe or prolonged cases)

Complications

Without proper management, complications can include:

  • Dehydration – especially during hot, humid West Michigan summers or if you’re not drinking enough fluids
  • Malabsorption of nutrients
  • Malnutrition
  • Significant weight loss

Are Collagenous and Lymphocytic Colitis Contagious?

  • No. Neither condition is contagious.
  • They are not caused by an infection you can “catch” from someone else.
  • They are not related to Crohn’s disease or ulcerative colitis, though all are forms of inflammatory bowel disease.

Causes and Risk Factors

Doctors are not entirely sure what causes the inflammation in microscopic colitis. Several factors may play a role:

Possible Causes

  • Abnormal immune response
    • The immune system may mistakenly attack healthy tissue in the colon (an autoimmune reaction).
    • People with collagenous or lymphocytic colitis may also have other autoimmune conditions, such as:
      • Rheumatoid arthritis
      • Scleroderma
      • Sjogren’s syndrome
  • Infection
    • A past or ongoing infection with an unknown virus or bacterium may trigger inflammation in some people.
  • Medications
    • Certain drugs may increase the risk or worsen symptoms, including:
      • Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and aspirin
      • Some acid-reducing medications and other prescription drugs (your Grand Rapids gastroenterologist can review your full list)
  • Genetic and environmental factors
    • Family history of autoimmune or inflammatory conditions
    • Environmental exposures, diet, and lifestyle may contribute, although no single factor has been proven.

In Michigan, seasonal factors—such as winter viral illnesses, reduced physical activity, and dietary changes—may influence symptom flares, but they are not known direct causes.

How Are These Conditions Diagnosed in Grand Rapids?

Because symptoms resemble other gastrointestinal disorders, such as irritable bowel syndrome (IBS), Crohn’s disease, and ulcerative colitis, careful evaluation is essential.

Diagnostic Steps

  1. Medical History

    • Review of symptoms, duration, diet, medications (including NSAIDs), and other health conditions.

  2. Physical Examination

    • General exam, abdominal exam, and assessment for signs of dehydration or malnutrition.

  3. Stool Tests

    • Stool culture and other tests to rule out infections (such as C. difficile or other bacterial causes of diarrhea).

  4. Colonoscopy

    • A slender viewing tube is inserted into the colon via the anus to view the entire colon.
    • In microscopic colitis, the colon usually looks normal to the naked eye.

  5. Flexible Sigmoidoscopy (in some cases)

    • A shorter scope to visualize the rectum and lower colon.
    • Again, the lining usually appears normal.

  6. Biopsy (Essential for Diagnosis)

    • Small samples of tissue are taken from different parts of the colon.
    • Under the microscope, a pathologist looks for:
      • Abnormally thick collagen layer → collagenous colitis
      • Build-up of lymphocytes in the epithelium → lymphocytic colitis

Multiple Biopsies Are Important

Because microscopic changes can be patchy, multiple biopsies from different colon segments are needed for an accurate diagnosis.

In Grand Rapids, these procedures are commonly performed at:

  • Corewell Health Butterworth Hospital & Blodgett Hospital
  • Trinity Health Grand Rapids
  • Metro Health – University of Michigan Health
  • Mercy Health gastroenterology clinics
  • Independent GI practices throughout Kent County

Treatment of Collagenous and Lymphocytic Colitis

There is no cure, but in most cases, symptoms can be well managed with lifestyle changes and medications. Treatment is tailored to the severity of your symptoms.

1. Watchful Waiting (Mild Cases)

  • Some people with very mild, intermittent symptoms may improve without formal treatment.
  • Your doctor may monitor you, especially if symptoms are not affecting your daily life.

2. Dietary Changes

Diet can play a major role in symptom control. In consultation with your provider (and possibly a dietitian in Grand Rapids), you may be advised to:

  • Reduce or avoid:
    • Fatty or greasy foods
    • Spicy foods
    • Milk and some dairy products (if lactose intolerant)
    • Sugary drinks (including many sodas and juices)
    • Caffeine (coffee, energy drinks, some teas)
    • Alcohol (beer, wine, spirits)
  • Limit gas-producing foods, such as:
    • Beans and lentils
    • Cabbage, broccoli, and other cruciferous vegetables
    • Carbonated or fizzy drinks
  • Choose gentler foods, especially during flares:
    • Bananas
    • White rice
    • Toast, plain crackers
    • Oatmeal and other soft, easy-to-digest foods

Eating tips for Grand Rapids residents:

  • Eat small, frequent meals throughout the day instead of three large meals.
  • Stay well-hydrated, particularly during hot, humid summers or if you are active outdoors along the Grand River or on local trails.
  • In winter, dry indoor air and less thirst can lead to dehydration—make a habit of drinking water regularly.

3. Adjusting Medications

Some medications, especially NSAIDs like aspirin and ibuprofen, can worsen symptoms in certain people.

  • Your doctor may:
    • Review all your medications (prescription, over-the-counter, and supplements).
    • Recommend switching from NSAIDs to other pain-relief options if possible.
    • Adjust or change other medications that might be contributing to diarrhea.

Never stop or change a prescription medication without talking to your healthcare provider.

4. Anti-Diarrheal Medications

  • Over-the-counter or prescription anti-diarrheal medications can:
    • Slow the passage of stool through the colon
    • Reduce stool frequency
    • Improve urgency and incontinence

These are often used under a doctor’s guidance, especially if you have other medical conditions.

5. Anti-Inflammatory and Steroid Medications

If diet changes and basic measures are not enough, your gastroenterologist may recommend:

  • Non-absorbable steroids (such as budesonide)
    • Act mainly in the gut with fewer whole-body side effects than traditional steroids
    • Often very effective at reducing diarrhea and inflammation
  • 5-aminosalicylic acid (5-ASA) medications
    • Anti-inflammatory drugs sometimes used to treat microscopic colitis

Treatment plans are usually personalized and may involve short-term courses of these medications with careful follow-up.

6. Surgery

  • Surgery is rarely necessary for collagenous or lymphocytic colitis.
  • It may only be considered in severe, treatment-resistant cases, which are uncommon.

Long-Term Outlook and Cancer Risk

  • There is no evidence that collagenous colitis or lymphocytic colitis increases the risk of colon cancer.
  • These conditions are not considered precancerous.
  • Many people in Grand Rapids live active, full lives with microscopic colitis once they find the right combination of diet, lifestyle, and medications.

Regular follow-up with your healthcare provider is still important to monitor symptoms, nutrition, and overall health.

Living With Microscopic Colitis in Grand Rapids

Managing chronic diarrhea can affect work, social life, and mental health. Local resources and strategies include:

  • Establish care with a gastroenterologist at:
    • Corewell Health, Trinity Health Grand Rapids, Metro Health, or Mercy Health
  • Coordinate with your primary care provider for ongoing support and medication management.
  • Ask about nutrition counseling, often available through hospital systems or local dietitians, to tailor a diet that fits your lifestyle and Michigan’s seasonal food options.
  • Plan ahead for bathroom access when traveling around the Grand Rapids area or attending events.
  • Stay vigilant about hydration during both summer heat and dry winter months.

Local Resources and Where to Get Help

If you live in Grand Rapids or the greater Kent County area and have persistent, watery diarrhea or other concerning digestive symptoms, seek medical evaluation.

Healthcare Providers

  • Your Primary Care Provider (PCP)
    • First stop for initial evaluation, stool tests, and referrals.
  • Gastroenterologist (GI specialist) in Grand Rapids
    • For colonoscopy, biopsies, and specialized treatment plans.

Major health systems where you can seek care:

  • Corewell Health (Spectrum Health) – Grand Rapids
  • Trinity Health Grand Rapids
  • Metro Health – University of Michigan Health
  • Mercy Health

Public Health and Community Resources

  • Kent County Health Department
    • Offers public health information, vaccination services, and guidance on infectious causes of diarrhea.
    • Website: search “Kent County Health Department Grand Rapids”
  • Grand Rapids Public Health and local clinics
    • Provide education, basic screening, and referrals, especially for underinsured or uninsured residents.

If you experience:

  • Signs of severe dehydration (dizziness, very dry mouth, rapid heartbeat, confusion)
  • Blood in your stool
  • Severe abdominal pain or fever

seek urgent medical care at a Grand Rapids emergency department or urgent care center.

Key Points

  • Collagenous colitis and lymphocytic colitis are forms of microscopic colitis that cause chronic, non-bloody, watery diarrhea.
  • In collagenous colitis, the collagen layer beneath the colon lining becomes thickened; in lymphocytic colitis, there is a build-up of lymphocytes in the epithelium.
  • The exact cause is unknown, but immune system problems, infections, and certain medications (especially NSAIDs) may contribute.
  • There is no cure, but diet changes, medication adjustments, anti-diarrheal drugs, and targeted anti-inflammatory treatments can manage symptoms in most people.
  • These conditions are not contagious and do not increase the risk of colon cancer.
  • Grand Rapids residents can access diagnosis and treatment through local health systems, gastroenterology clinics, and public health resources in Kent County.