Lymphocytic colitis: an Important but Underdiagnosed Cause of Chronic Diarrhoea in Adult Nigerians

  • Kenechukwu Okonkwo University of Medical Sciences, Ondo State
  • Olusegun Ojo Department of Department of Morbid Anatomy and Forensic Medicine, Obafemi Awolowo University, Ile-Ife
  • Omolade Betiku Department of Department of Morbid Anatomy and Forensic Medicine, Obafemi Awolowo University, Ile-Ife
Keywords: Lymphocytic colitis, chronic diarrhoea, Nigeria


Introduction: Lymphocytic colitis is an important cause of chronic diarrhoea which is amenable to appropriate treatment which helps to reduce the morbidity and mortality associated with chronic diarrhoea. In Africa unfortunately, there is poor awareness of this treatable cause of chronic diarrhoea on account of a paucity of skilled experts necessary to make a diagnosis and implement effective therapy.

Aim: We present the clinical aspects, endoscopic findings and pathological features of twenty-one Nigerian patients with lymphocytic colitis. A short literature review of the epidemiological, clinical, endoscopic, and pathological features of this important condition is also presented.

Materials and Methods: This was a retrospective analysis of the clinical, endoscopic and pathological findings of twenty-one patients who were diagnosed with lymphocytic colitis following colonoscopy in an open-access endoscopy setting in Akure, Ondo State, Nigeria over eighteen months.

Results: Twenty-one diagnoses of lymphocytic colitis were made from a pool of one hundred and twenty-two colonoscopies done between December 2021 and May 2023. There were slightly more females diagnosed with an M: F ratio of 3:4 with a mean (SD) age of 52.2 (± 14.3) years. All of the patients had a history of passage of watery diarrhoea while normal colonoscopy findings were present in 87.5%. The mean (SD) time to diagnosis in five of these study subjects was 18.4 ± 9.1 months. These patients had standard medical treatment with good outcomes.

Conclusion: In sub-Saharan Africa, lymphocytic diarrhoea is a treatable cause of chronic diarrhoea. It is important to refer patients with chronic diarrhoea to facilities where they can benefit from the expertise of endoscopists and pathologists.


Download data is not yet available.


1. Arasaradnam RP, Brown S, Forbes A, Fox MR, Hungin P, Kelman L, et al. Guidelines for the investigation of chronic diarrhoea in adults: British Society of Gastroenterology, 3rd edition. Gut. 2018 Aug;67(8):1380–99.
2. Mohamed N. Microscopic colitis as a missed cause of chronic diarrhea. World J Gastroenterol. 2011;17(15):1996.
3. Read NW, Krejs GJ, Read MG, Santa Ana CA, Morawski SG, Fordtran JS. Chronic diarrhea of unknown origin. Gastroenterology. 1980;78(2):264–71.
4. Lazenby AJ, Yardley JH, Giardiello FM, Jessurun J, Bayless TM. Lymphocytic (“microscopic”) colitis: A comparative histopathologic study with particular reference to collagenous colitis. Hum Pathol. 1989 Jan;20(1):18–28.
5. Ekrikpo UE, Otegbayo JA, Oluwasola AO. Lymphocytic colitis presenting as difficult diarrhoea in an African woman: a case report and review of the literature. J Med Case Rep. 2010 Dec 29;4(1):31.
6. Oluyemi A, Momoh M, Odeghe E, Keshinro S. Lymphocytic Colitis in Nigeria: A Case Series. Annals of African Surgery. 2021 Jul 20;18(3):180–4.
7. Mudenda V, Malyangu E, Sayed S, Fleming K. Addressing the shortage of pathologists in Africa: Creation of a MMed Programme in Pathology in Zambia. Afr J Lab Med. 2020 Jun 3;9(1).
8. Perl D, Leddin D, Bizos D, Veitch A, N’Dow J, Bush-Goddard S, et al. Endoscopic capacity in West Africa. Afr Health Sci. 2016 May 9;16(1):329.
9. Pihl Lesnovska K, Münch A, Hjortswang H. Microscopic colitis: Struggling with an invisible, disabling disease. J Clin Nurs. 2019 Oct 29;28(19–20):3408–15.
10. Olesen M. Microscopic colitis: a common diarrhoeal disease. An epidemiological study in Orebro, Sweden, 1993-1998. Gut. 2004 Mar 1;53(3):346–50.
11. Tysk C, Bohr J, Nyhlin N, Wickbom A, Eriksson S. Diagnosis and management of microscopic colitis. World J Gastroenterol. 2008;14(48):7280.
12. Williams JJ, Kaplan GG, Makhija S, Urbanski SJ, Dupre M, Panaccione R, et al. Microscopic Colitis–Defining Incidence Rates and Risk Factors: A Population-Based Study. Clinical Gastroenterology and Hepatology. 2008 Jan;6(1):35–40.
13. Wickbom A, Bohr J, Eriksson S, Udumyan R, Nyhlin N, Tysk C. Stable Incidence of Collagenous Colitis and Lymphocytic Colitis in Örebro, Sweden, 1999–2008. Inflamm Bowel Dis. 2013 Oct;19(11):2387–93.
14. Tong J, Zheng Q, Zhang C, Lo R, Shen J, Ran Z. Incidence, prevalence, and temporal trends of microscopic colitis: a systematic review and meta-analysis. Am J Gastroenterol [Internet]. 2015 Feb 5 [cited 2023 Feb 4];110(2):265–76.
15. Tong J, Zheng Q, Zhang C, Lo R, Shen J, Ran Z. Erratum: Incidence, Prevalence, and Temporal Trends of Microscopic Colitis: A Systematic Review and Meta-Analysis. American Journal of Gastroenterology. 2015 Jul;110(7):1121.
16. Veress B, Lofberg R, Bergman L. Microscopic colitis syndrome. Gut. 1995 Jun 1;36(6):880–6.
17. Olesen M. Lymphocytic colitis: a retrospective clinical study of 199 Swedish patients. Gut. 2004 Apr 1;53(4):536–41.
18. Münch A, Langner C. Microscopic Colitis: Clinical and Pathologic Perspectives. Clinical Gastroenterology and Hepatology. 2015 Feb;13(2):228–36.
19. Pardi DS, Ramnath VR, Loftus E V., Tremaine WJ, Sandborn WJ. Lymphocytic colitis: clinical features, treatment, and outcomes. Am J Gastroenterol. 2002 Nov;97(11):2829–33.
20. Storr MA. Microscopic Colitis: Epidemiology, Pathophysiology, Diagnosis and Current Management—An Update 2013. ISRN Gastroenterol. 2013 Apr 18;2013:1–12.
21. Choi K, Samdani R, Shuttlesworth G, Wang Y. P016 case series: immunotherapy-induced lymphocytic colitis. Gastroenterology. 2018 Jan;154(1):S9.
22. Koskela RM, Niemelä SE, Karttunen TJ, Lehtola JK. Clinical characteristics of collagenous and lymphocytic colitis. Scand J Gastroenterol. 2004 Jan 8;39(9):837–45.
23. Kao KT, Pedraza BA, McClune AC, Rios DA, Mao YQ, Zuch RH, et al. Microscopic colitis: A large retrospective analysis from a health maintenance organization experience. World J Gastroenterol. 2009;15(25):3122.
24. Mellander MR, Ekbom A, Hultcrantz R, Löfberg R, Öst Å, Björk J. Microscopic colitis: a descriptive clinical cohort study of 795 patients with collagenous and lymphocytic colitis. Scand J Gastroenterol. 2016 May 3;51(5):556–62.
25. Koskela RM, Karttunen TJ, Niemelä SE, Lehtola JK, Ilonen J, Karttunen RA. Human leucocyte antigen and TNFα polymorphism association in microscopic colitis. Eur J Gastroenterol Hepatol. 2008 Apr;20(4):276–82.
26. Jackson K. Are Collagenous Colitis and Lymphocytic Colitis Distinct Syndromes? Digestive Diseases. 1995;13(5):301–11.
27. Bonderup OK, Nielsen GL, Dall M, Pottegård A, Hallas J. Significant association between the use of different proton pump inhibitors and microscopic colitis: a nationwide Danish case-control study. Aliment Pharmacol Ther. 2018 Sep;48(6):618–25.
28. Keszthelyi D, Jansen S V., Schouten GA, De Kort S, Scholtes B, Engels LGJB, et al. Proton pump inhibitor use is associated with an increased risk for microscopic colitis: a case-control study. Aliment Pharmacol Ther. 2010 Nov;32(9):1124–8.
29. Baert F, Wouters K, D’Haens G, Hoang P, Naegels S, D’Heygere F, et al. Lymphocytic colitis: a distinct clinical entity? A clinicopathological confrontation of lymphocytic and collagenous colitis. Gut. 1999 Sep 1;45(3):375–81.
30. Gueye MN, Diop SN, Diallo S, Diouf G, Cissé CAB, Fall MP, et al. Ulcerative Colitis in Sub-Saharan Africa: Analysis of 24 Cases in Dakar (Senegal). Open J Gastroenterol. 2020;10(06):128–36.
31. Loreau J, Duricova D, Gower-Rousseau C, Savoye G, Ganry O, Ben Khadhra H, et al. Long-Term Natural History of Microscopic Colitis: A Population-Based Cohort. Clin Transl Gastroenterol. 2019 Sep;10(9):e00071.
32. Nielsen OH, Fernandez-Banares F, Sato T, Pardi DS. Microscopic colitis: Etiopathology, diagnosis, and rational management. Elife. 2022 Aug 1;11.
33. Malik A, Nadeem M, Javaid S, Malik MI, Enofe I, Abegunde AT. Estimating the optimum number of colon biopsies for diagnosing microscopic colitis: a systematic review. Eur J Gastroenterol Hepatol. 2022 Jul 14;34(7):733–8.
34. Virine B, Chande N, Driman DK. Biopsies From Ascending and Descending Colon Are Sufficient for Diagnosis of Microscopic Colitis. Clinical Gastroenterology and Hepatology. 2020 Aug;18(9):2003–9.
35. Topel G, Cakir E, Aydin I, Dilek FH, Sari AA. Analysis of clinical and histopathological findings in microscopic colitis. Turkish Journal of Pathology. 2022; 38(8):275-283
36. Fernández-Bañares F, Casanova MJ, Arguedas Y, Beltrán B, Busquets D, Fernández JM, et al. Current concepts on microscopic colitis: evidence-based statements and recommendations of the Spanish Microscopic Colitis Group. Aliment Pharmacol Ther. 2016 Feb;43(3):400–26.
How to Cite
Okonkwo K, Ojo O, Betiku O. Lymphocytic colitis: an Important but Underdiagnosed Cause of Chronic Diarrhoea in Adult Nigerians. Int J Med Res Rev [Internet]. 2024Jul.10 [cited 2024Jul.17];12(3). Available from:
Original Article