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Collagenous Colitis- Causes, Symptoms, Diagnosis, and Management

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Collagenous colitis is an inflammatory disorder of the small and large intestines. Colitis could be due to microbes, indigestion, and other unknown factors. Read below to know more.

Medically reviewed by

Dr. Ghulam Fareed

Published At December 23, 2022
Reviewed AtDecember 28, 2023


Collagenous colitis is also known as diarrheal disease. It can occur in the small or large intestine. It can sometimes develop into ulcerative lesions with inflammation. Globally, enterocolitis cases are distributed at different proportions in different places. Almost half the disease pediatric population dies due to this condition annually. Another triggering factor for this condition is frequent international travel.

What Is Collagenous Colitis?

This condition occurs anywhere in the body, from the gastrointestinal tract to the rectal region. It can sometimes develop into ulcerative lesions with inflammation. It is an inflammatory condition of the small intestine followed by diarrhea. They are also known as idiopathic inflammatory diseases. Such colon inflammation could be due to microbial invasion, genetic predisposition, or other immunological responses caused due to changed gut flora. Activating inflammatory cells like neutrophils can damage the tissue wall and cause injury. The collective response gives rise to diarrhea and other functional abnormalities of the colon.

What Are the Different Types of Diarrhea?

Diarrhea is a medical condition where stool is excreted in large quantities, with loose consistency and frequent stool dissemination. An average human stool weighs around 250 gms. Out of which 70 % to 95 % is water content. During severe diarrhea, about 14 liters of water is lost. Depending on such factors, diarrhea is classified into five types:

  • Secretory Diarrhea: It has intestinal-rich plasma, which is isotonic fluid. This is mainly caused by Rotavirus, Escherichia coli, Clostridium perfringens, and excessive use of laxatives.

  • Osmotic Diarrhea: This is caused by over-exertion on the luminal wall causing high osmotic pressure. The causative agents are antacids, lactulose therapy, and gut lavages.

  • Exudative Disease: This is followed by heavy and frequent passing of stool. The stool is filled with bloody discharge. It is caused by Shigella spp, Salmonella spp, and Campylobacter spp.

  • Malabsorption: It is caused by indigestion. The stool is bulky but rich in osmolarity. This is mainly caused due to malabsorption of food, especially fatty substances (steatorrhea), and infections caused by Giardia lamblia.

  • Deranged Motility: Irregular stool output, volume, and consistency are followed by irregular stool output. The main causative factors are neural dysfunction, reduced gut length, hyperthyroidism, intestinal loop, and bacterial growth in the intestines.

What Are the Symptoms of Colitis?

Diarrheal disease like colitis is followed by symptoms such as.

  • Abdominal pain.

  • Discomfort in the anal region.

  • Diarrhea.

  • Fatigue.

  • Bloody stool or dysentery.

  • Lack of control over urination and stool passing (incontinence).

  • Low-volume stool.

  • Dehydration.

  • Bloating.

How Do Genetics, Immune Response, and Microbial Factors Play a Role in Collagenous Colitis?

Factors triggering inflammation of the colon could be due to dynamic reasons. Most of the etiology is still unknown. However, some of the pathogenesis are

  • Genetics: Studies have been conducted at the genetic level to study gene variations. Certain chromosomal variations are noted concerning chromosomes 3, 7, 12, and 16 causing bowel disease.

  • Immune Response: An imbalanced immune regulation can lead to bowel inflammation. As a result of the immune response, there are elevated levels of T and B cells in the gut mucosa, which is another contributing factor to inflammation.

  • Microbial Factors: Microbial infection or bacterial proliferation in the gut can lead to idiopathic inflammatory bowel disease.

Who Is at Risk of Developing Collagenous Colitis?

Some risk factors are associated with collagenous colitis as this is a multifactorial disease, such as

  • Diabetic patients.

  • Autoimmune disease.

  • Women are more affected than men.

  • People who have high cholesterol levels.

  • Smokers.

  • Medications like non-steroidal anti-inflammatory drugs (NSAIDs), selective serotonin reuptake, proton pump, and statins.

  • Patients on painkillers.

  • Thyroid disease.

  • Celiac disease.

  • Irritable bowel syndrome.

  • The rate of occurrence is higher in the older population, around fifty to sixty years.

What Are the Diagnostic Tests for Collagenous Colitis?

Tests to check for colitis condition are.

  • Blood Tests: Blood tests are not as revealing to confirm the diagnosis. Usually, patients may show a high erythrocyte sedimentation rate, autoantibodies, mild anemic conditions, and inflammatory factors in the blood.

  • Stool Tests: A high protein concentration exists in the stool. Other toxins include Clostridium difficile, Escherichia coli, and the presence of other parasites.

  • Colonoscopy: This is done to visualize the colon. It usually appears normal on colonoscopy.

  • Endoscopy Test: This standard test to check for collagenous colitis. An endoscopy of the lower gastrointestinal system is done. A colonoscope is inserted into the gut to visualize the colon up to the rectum. The physician advises the patient to stop any blood thinners intake one week before the test. This prevents excessive bleeding. The test is conducted while the patient is on a fast for at least eight hours. A laxative is given to clean up the bowel before conducting the test. The image is captured in the monitor, and further analysis is made.

  • Biopsy: A tissue sample is collected and studied under the microscope to confirm the diagnosis. The sub-epithelial fibrous bands more than ten millimeters in size are seen.

How Can We Treat Collagenous Colitis?

Treatment includes stopping any factor which can trigger or worsen the condition. Certain drugs and habits like smoking are highly associated with collagenous colitis. Some of the best treatment plans are.

  • Cessation of smoking.

  • Stopping harmful medications which can harm the mucosa, like non-steroidal anti-inflammatory drugs.

  • Administration of Budesonide (steroid) for severe diarrhea for six to eight weeks. If the symptoms persist, Cholestyramine is given four times a day until the symptoms stop.

  • Bismuth subsalicylate can be given if diarrhea does not stop even after two weeks, as the physician prescribes.

  • Not all patients respond positively toward treatment. Further surgery is recommended in severe conditions with an underlying cause of necrosis or tumor. Surgical procedures like ileotomy and subtotal colectomy are done.

  • Management of diet should be taken care of. Avoid foods like dairy products and fatty substances, which can promote defecation. Reduce caffeine and alcohol intake.


The primary cause of chronic diarrhea in patients is collagenous colitis. The increased bowel movements are responsible for frequent watery stool discharge, which is non-bloody. The patient is extremely tired, and immediate care must be given. A very less percentage of collagenous colitis is associated with colorectal cancer. Hence, the prognosis is good enough to get it treated. This can develop gradually or immediately with episodes of stool discharge more than thrice daily for four or more weeks.

Frequently Asked Questions


Definition of Collagenous Colitis?

Microscopic colitis that affects the large intestine is called collagenous colitis. In colon tissue, a thick coating of protein (collagen) forms. Most typically, middle-aged and older women with collagenous colitis experience watery, non-bloody diarrhea.


What Does Collagenous Colitis Look Like?

Inflammation of the colon, the last section of the gut that empties into the anus, is a symptom of collagenous colitis and inflammatory bowel disease (IBD). Collagenous colitis is characterized by persistent, watery diarrhea, which can occur five to ten times daily.


Is It Possible to Cure Collagenous Colitis?

Although there is no known cure, medication can control the symptoms. Depending on how severe the symptoms are, there are many treatment options, such as watchful waiting: for unexplained causes, some individuals with minor symptoms get well without any kind of treatment.


How to Naturally Treat Collagenous Colitis?

 - Consume a diet low in fiber and fat. Foods that are low in fiber and fat might alleviate diarrhea.
 - Eliminate gluten, dairy products, or both. These foods could exacerbate the symptoms.
 - Avoid sweets and caffeine.
 - Stop taking any medications that might be contributing to the symptoms.


How to Develop Collagenous Colitis?

Although the exact cause of collagenous colitis is unknown, it is believed to have several causes. This indicates that hereditary and environmental factors may influence a person's risk of developing the disease. Genetic disorders are one of the potential causes of collagenous colitis. Autoimmune diseases such as Crohn's disease, psoriasis, and rheumatoid arthritis. Some viruses or bacteria can be the cause.


What Triggers a Flare-up of Collagenous Colitis?

Some people may develop triggers from viral and bacterial illnesses, specific medications, or specific meals. For example, nonsteroidal anti-inflammatory medicines (NSAIDs) and selective serotonin reuptake inhibitors (SSRIs), the most often prescribed family of antidepressants, can cause collagenous colitis.


Collagenous Colitis: Does It Ever Get Better?

Most people get remission with little to no treatments or symptoms that go away completely. However, in some people, chronic diarrhea or sporadic recurring episodes of diarrhea occur, necessitating continued medicine. Despite the lack of a confirmed treatment, medicines help manage the symptoms.


The Best Way to Treat Collagenous Colitis?

Relapses in collagenous colitis are typical and can occur at any time. In order to get rid of the symptoms, one might have to attempt multiple different therapies like:
 - Bismuth subsalicylate.
 - Cholestyramine.
 - Injections, tablets, or other forms of immunotherapy.


Can Collagenous Colitis Cause Death?

Collagenous colitis symptoms can be treated using a variety of methods. Few individuals do, however, fully recover from their illness. Ongoing research is being done to determine the ideal length of treatment. The risk is elevated if the disease affects a portion of the colon. If the entire colon is affected, the danger is greatest. Rarely, ulcerative colitis can cause death when serious complications arise.


What Is the Prevalence of Collagenous Colitis?

It has been challenging to record this disorder's natural history. However, collagenous colitis has been the subject of recent long-term investigations. Those studies have shown that the condition typically has a benign clinical history, at least throughout the assessment phase, which lasts for around ten years.
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Dr. Ghulam Fareed
Dr. Ghulam Fareed

Medical Gastroenterology


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