Successful Treatment of Lymphocytic Colitis With a Honey Lavage

To the Editors,

Microscopic colitis is a frequent cause of nonbloody chronic watery diarrhea. The diagnosis of microscopic colitis is based upon mucosal biopsy of the colon with specific histologic features in the mucosa. There are 2 subtypes, collagenous colitis and lymphocytic colitis, based on a subepithelial collagen band and increased intraepithelial lymphocytes, respectively. Although its exact etiology is unknown, the disorder is associated with medication such as nonsteroidal anti-inflammatory drugs and proton pump inhibitors and autoimmune disorders such as celiac disease, polyarthritis, and thyroid disorders.¹ The standard therapy for microscopic colitis consists of glucocorticosteroids, antidiarrheals, and cholestyramine. Although these treatments often cause cessation of symptoms, relapses are seen in a large percentage of cases.^{2, 3} Nonresponders will receive glucocorticosteroids maintenance therapy, immunomodulators, or even biologicals with its broad array of adverse effects.⁴

Recently, we have shown that an antibiotic therapy–resistant Clostridium difficile infection can successfully be treated with a honey lavage.⁵ We repeated this several times, until we encountered a patient that also had microscopic colitis. Remarkably, the diarrhea associated with the Clostridium difficile infection and probably microscopic colitis completely disappeared after the honey lavage. This prompted us to research honey as a potential treatment for microscopic colitis. Here, we describe the first time (to our knowledge) multiple cases of patients with microscopic colitis successfully being treated with a honey lavage.

So far, 12 patients underwent an experimental honey lavage with a 300-mL solution of 20% Manuka honey (MGO 550), administered during colonoscopy with a spray catheter throughout the colon and terminal ileum. Manuka honey is graded using methylglyoxal (MGO), a phytochemical compound shown to have an antibacterial action.⁶ The therapeutic mechanism of honey has not yet been fully elucidated. The antibacterial effect has been attributed to osmolarity, hydrogen peroxide generation, and phytochemical components. However, honey has been shown to have an anti-inflammatory function and antibacterial activity.

All participants were female (mean age 58 years); 8 patients had lymphocytic colitis, and the other 4 had collagenous colitis. Patients had experienced nonbloody watery diarrhea for at least 2 months and up to 4 years at the time of the honey lavage. Nine patients have unsuccessfully been treated with regular medication; 3 patients chose to receive the honey lavage without trying any regular therapy.

After the procedure, 6 out of the overall 12 patients experienced complete remission of symptoms (ie, cessation of watery stools) immediately after the 1-time honey lavage. All patients successfully treated were suffering from lymphocytic colitis. Of the 2 lymphocytic colitis patients in which symptoms persisted, 1 patient was also suffering from pancreatic insufficiency—probably the cause of her diarrhea. For the other patient who underwent the honey lavage twice, no other reason was found for her persisting diarrheal symptoms than the lymphocytic colitis itself.

The follow-up period of the patients successfully treated ranges from 6 months to 4 years, with an average period of 2 years. During the follow-up period, 1 patient was asymptomatic for 2.5 years when the patient developed diarrhea following a Campylobacter jejeuni infection.

Our findings suggest that a honey lavage with a honey solution seems to be efficient for the treatment of lymphocytic colitis, as opposed to collagenous colitis. The observed selective efficacy of honey therapy leads us to believe that there might be differences in etiology between lymphocytic and collagenous colitis. The results suggest an underlying bacterial component in the etiology of lymphocytic colitis. However, these findings could serve as an incentive to further research investigating the differences between disease entity and could also help advance the research for new therapeutic options.

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