MC's association with Irritable Bowel Syndrome

[harvest_table]

This is an interesting article.

Is there an association of MC and Irritable bowel Syndrome-a subgroup analysis of placebo-controlled trials© 2005 The WJG Press and Elsevier Inc. All rights reserved.

TO THE EDITOR
With great interest we read the recent retrospectice study by Barta et al (1) dealing with the clinical presentation of patients with microscopic colitis. They investigated in a cohort of 53 patients with microscopic colitis (46 with collagenous colitis, 7 with lymphocytic colitis) the relationship between microscopic colitis and both constipation and diarrhea. One of their mean finding was that abdominal pain, diarrhea and constipation was a common symptom complex of patients with microscopic colitis, thus the face of microcopic colitis resembles the subgroups of irritable bowel syndrome (IBS).
Irritable bowel syndrome is highly prevalent disorder. Consensus diagnostic criteria (Rome II) based on symptoms have been established to aid the diagnosis of IBS. Microscopic colitis, encompassing collagenous and lymphocytic colitis, is diagnosed by histologic criteria. Since symptoms of microscopic colitis and both diarrhea predominant irritable bowel syndrome or functional diarrhea are similar, a considerable number of patients with micoscopic colitis may be misdiagnosed as IBS or functional diarrhea or a disease overlap could be present in a subgroup of patients. We would like to confirm the data by Barta et al [1] presenting a subgroup analysis of placebo-controlled trials, in which we evaluate the possible symptom overlap between microscopic colitis and IBS. We aimed to assess the proportion of patients with histologically confirmed microscopic colitis who fulfill the Rom-II-criteria for IBS and functional diarrhea[2] .
We selected a large patient cohort with histologically confirmed symptomatic microscopic colitis, who participated in placebo-controlled trials of our group. Baseline gastrointestinal symptoms were assessed by standardized questionnaires and ascertained consistent with Rome-II-criteria (chronic abdominal pain and/or stool abnormalities for at least 12 wk in the preceding 12 mo, no alarm symptoms such as weight loss, no findings in the routine procedures including colonoscopy).
Eighty-two cases of microscopic colitis (74 collagenous, 8 lymphocytic) were included in this analysis. The mean age was 57 years (30-80). Seventy-three % were women. The mean stool frequency per day was 6 (range 3-15). The duration of symptoms prior to histological diagnosis of microscopic colitis ranged between 1 and 156 mo with a mean of 28 mo. Forty-seven patients (57.3%) had concomitant abdominal pain.
Twenty-three patients (28.1%) met the Rome-II-criteria for diarrhea-predominant IBS. Six patients (7.3%) fulfilled the criteria for functional diarrhea. If the criteria for duration of symptoms were excluded from our analysis, the corresponding rates were 65% and 13.4%, respectively These data clearly demonstrate that a considerable group of patients with microscopic colitis have diarrhea-predominant IBS- or functional diarrhea-like symptoms. Thus, patients with microscopic colitis could be misdiagnosed as IBS or functional diarrhea. Additionally, because of the high frequency of IBS, a disease overlap could be present in a subgroup of patients as it was shown between IBS and celiac disease[3]. We conclude that the clinical symptom-based criteria of IBS are not specific enough to rule out the diagnosis of microscopic colitis. Therefore, patients with diarrhea-predominance of IBS-like symptoms should undergo matrix biopsies from the entire colon to investigate for possible microscopic colitis especially biopsies from the right colon are of importance because the left colon sometimes is less involved

http://www.wjgnet.com/1007-9327/11/6409.asp

Love,
Joanna

[Polly]

Great find, Joanna!

We have often said here that MC can be misdiagnosed as IBS, and in fact, this has happened to some of our members. However, this is the first good study to prove it that I have seen. Hallelujah! Maybe docs will ALWAYS take biopsies now whenever IBS is suspected. Will you please put this in the Current Research Forum? - don't want to lose it.

Thanks.

Love,

Polly

[harvest_table]

Sure Polly, I'll post it there.

I was wondering about Andrew's DX? Andrew, you out there? If I recall, you did not have MC or UC right? Were you DX with IBS?

Specifically, did you have matrix biopsies from the left and right sides of your colon? Just curious. How are you doing by the way?

Love,
Joanna

[Sally]

Finallly!!! We have been saying the same thing for years. Why go to all the trouble of doing a colonoscopy without doing biopsies while you're in there?

Thanks, Joanna, for finding this article and for posting it.

Love,

Sally

[mle_ii]

Agreed. At first I was diagnosed with IBS.
After looking at the colon and taking biopsies (no analysis yet of the biopsies) they said IBS.
After analysis of the biopsies I have Lymphocytic Colits.

And since my small intestine wasn't looked at who knows what else I might have.

[CAMary]

Mike-

The same thing happened to me! My GP said IBS but I knew something else was going on - luckily We have PPO insurance, so I didn't need a referral to a gastro guy. I found a gem (by chance) who was concerned about my pain and weight loss, and decided to do a scope - in recovery he said "IBS" and when he called me a week later to say the biopsy said CC, he admitted he was very surprised - probably non-typical gender or age catches these guys off guard! I remember asking my husband why would they do a biopsy if there were no polyps present - I wasn't aware of what they might be looking for!

[harvest_table]

Yes! There must be lots of folks out there with an IBS DX, that do indeed have MC. Also, it looks like those of us with MC can also have IBS...it's all interesting. Here's another long study of MC, IBS and Autoimmune issues.

MC- retrospective study of clinical presentations in 53 patients

Abstract AIM: To evaluate the relationship between symptoms and microscopic colitis (MC) subtypes: to test whethercollagenous colitis (CC) and/or lymphocytic colitis (LC)might be related to both constipation and diarrhea.METHODS: A cohort of patients with independentlyconfirmed typical histopathological changes wasinvestigated. Fifty-three patients with histologically provedMC (46 with CC, 7 with LC) were included. The existenceof diarrhea or constipation and the co-existence ofautoimmune diseases were also investigated and all datawere retrospectively analyzed.RESULTS: Twenty-three (43.39%) of MC patients hadchronic constipation (20 in CC, 3 in LC patients). Twenty-four (45.28%) of MC patients had autoimmune diseaseand the diagnosis of autoimmune disease was alwaysprior to MC. Sjögren’s syndrome was associated only withthe constipation subgroup.CONCLUSION: The Janus face of MC resembles thesubgroups of irritable bowel syndrome. The co-existenceof autoimmune diseases and MC is confirmed in both theconstipation and diarrhea subgroups

http://72.14.203.104/search?q=cache:-ap ... =clnk&cd=3

Looks like MC is finally getting more airtime (probably by default) since IBS & IBD is so common and casually DX and they are finding IBS & it's subtypes curiously intertwined with MC & it's subtypes. Oh, and don't forget MC's relationship to Celiac! I hope Dr. Fine will publish his findings soon. What a puzzle.

Love,
Joanna

[Peggy]

We have been saying it a long time, haven't we Sal? Think maybe some reseachers are reading our posts?

Thanks J!

Love
Peg