MC'S association with Irritable Bowel Syndrome

[harvest_table]

Is there an association of microscopic colitis and irritable bowel syndrome-A subgroup analysis of placebo-controlled trials
Ahmed Madisch, Birgit Bethke, Manfred Stolte, Stephan Miehlke

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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

[harvest_table]

Another link with IBS
http://www.ncbi.nlm.nih.gov/sites/entre ... stractPlus

[tex]

Thanks for "freshening" up this topic. I somehow overlooked it when you originally posted it.

This makes me wonder if anyone has ever checked to verify whether or not all patients diagnosed with IBS might actually have MC.

Tex

[harvest_table]

Hey Tex,

Unless a biopsy of the colon is the GI's plan or requested by the patient at the time of diagnosing -MC may be lost forever as a player in all this, even when it may have been there from the onset. It creeps in later with other problems for sure.

Here is Doc Lewey again .

http://ezinearticles.com/?Irritable-Bow ... &id=455365

Love,
Joanna

[tired of it all]

Hi everyone-

I am a newbie here so bear with me. I was diagnosed with MC last year & while living in Charlotte, N.C., I was told I had IBS. After my colonoscopy , I finally found out that I had MC instead. So there you go; another generalized diagnosis. I have been on Entocort several times & it certainly worked well for me until after going off of it for about a month at the most, then it was all back to the big D My Dr. has never talked to me about diet etc, except for dairy. However, after reading your information here, I've learned so much more! Thank you all so much! At least now I feel a little more up on the subject. This last flare up has been dreadful. A lot of cramping & a lot of D. After consulting the Dr. a few days ago, it's back to the Entocort 3 pills a day, then 2; you probably know the routine. Even though the E works for me, at times it raises my BP. I've told my Dr. about this & he informed me that that wasn't possible. So we have a conflict here! I have been trying myself, to cut back on the gluten & dairy. Real fun when I honestly don't know a whole lot about it, except that people who have our problems seem to have a sensitivity to these things. It's difficult to do this by myself because so far, my Dr. doesn't seem to be interested in talking about it; at least not yet. Also I've been on Culturelle to see if that would help things to be more balanced. I noticed that I had a lot more gas with it even though I felt better as a whole. Since starting the E again I've stopped the Culturelle so as not to disturb the E. Sometimes I feel like I'm chasing my own tail !! Does anyone have any info on Probiotics?
It's great that you have this support group . Seems like a lot of people think oh well, gee that's not so bad to deal with! If they only lived with it! Thanks for letting me vent & hope to hear a lot more from you all! Karen

[Gloria]

WELCOME, KAREN!!

As you've read here, your experience is pretty typical. Many of us go to our doctors to get our meds and then proceed to treat our MC by adjusting our diet. Most GIs do not acknowledge a relationship between diet and MC, but we here know better.

I use Dairy-Free Culturelle because I am intolerant to dairy. You might want to switch to the DF version, if you're using the regular one. We have found that it's not sufficient to cut back or reduce an intolerant food; we have to eliminate it completely if we want our symptoms to go away.

Many of us have found Enterolab testing to be very helpful in helping determine our food intolerances. You might want to read their website www.enterolab.com for more information.

Keep reading here - there is a wealth of information accumulated over the years. You can get your life back and you will get better. We are here to help guide you.

Gloria

[tired of it all]

Hi Gloria Thank you for the welcome! I appreciate it.


I do use the DF Culturelle or I should say did use it. I'm eliminating it for now using the Entocort. It truly is a trial by elimination involving the foods. I will do whatever I must do though.

I will check out that website. Thanks!

[tex]

Hi Karen,

Welcome to our internet family. We consider ourselves a family, because no one truly understands this disease, unless they have it.

Your doctor is just plain wrong if he claims that Entocort cannot increase blood pressure. Any doctor should be well aware that taking any corticosteroid increases the risk of issues with elevated blood pressure. Hypertension is a listed adverse reaction for budesonide, (budesonide is the active ingredient in Entocort EC), on drug websites for professionals, such as this one:

Adverse Reactions

Cardiovascular

Oral

Hypertension, migraine, palpitations, syncope, tachycardia (less than 5%).

http://www.drugs.com/ppa/budesonide.html

There are many other websites that list high blood pressure as a possible side effect of budesonide. Here are a couple more:

In older people, corticosteroids may increase the risk of high blood pressure and bone disease. Bone problems from corticosteroids are especially likely in older women.

http://arthritis-symptom.com/arthritis- ... eroids.htm

Budesonide side effects
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have any of these serious side effects:

*

changes in the shape or location of body fat (especially in your arms, legs, face, neck, breasts, and waist);
*

increased blood pressure (severe headache, fast or uneven heart rate, blurred vision); or
*

general ill feeling with headache, tiredness, nausea, and vomiting.

Less serious side effects may include:

*

thinning of the skin, easy bruising;
*

headache;
*

runny or stuffy nose, cough, sore throat;
*

muscle pain;
*

mild nausea, stomach pain, indigestion;
*

mild skin rash; or
*

changes in your menstrual periods.

http://www.drugs.com/mtm/budesonide.html

If you ask your doctor about Enterolab, he will very likely tell you that those stool tests are worthless for treating MC, but if he does, he will be wrong again.

Most of us only use our GI specialist to get a diagnosis, and to write prescriptions, (if we choose to take a medication to treat the disease). After that, we learn from each other, here, how to control the symptoms, and how to maintain remission.

Again, welcome aboard, and please feel free to ask anything.

Tex

[tired of it all]

Hi Tex Thank you, thank you,& thank you! I had read the SAME thing. After telling him what I had read regarding BP, THEN he suggested taking BP meds. I mean "REALLY"! Who wants to keep taking one pill after another? I am so disgusted with this MD & won't be able to see him again until May3. I have no choice at this time to stop the Entcort since it does help the D. What to do??? Thanks again Karen

[tex]

After telling him what I had read regarding BP, THEN he suggested taking BP meds. I mean "REALLY"! Who wants to keep taking one pill after another?

Yep, doctors love to write prescriptions.

I have no choice at this time to stop the Entcort since it does help the D. What to do???

Drug dosages are determined in trials, based on responses by "average" individuals. However, some people are much more sensitive to certain drugs than "average". We have at least 2 or 3 members who get the full benefit from only one Entocort capsule per day, and if they take more, they have severe side effects. You might try reducing the dosage, to see if the side effects go away, (or maybe they will diminish, so that they are no longer a problem), and you might still be able to get an adequate benefit from the reduced dose. We have a few members, though, who had to stop taking it completely, because their side effects were still intolerable, (balance issues, blurred vision, vertigo, etc.), even with a minimal dose.

In the meantime, concentrating on diet changes might eventually enable you to control your symptoms by diet alone, so that you will be able to do without the Entocort. Or, you could try one of the various brands of mesalamine, (Lialda, Apriso, Colazal, Pentasa, Asacol, etc.). These are not quite as effective as Entocort, but they work for some people. Your GP might be willing to write you a prescription for one of those meds, to take the place of Entocort, since you can't see your GI specialist until next month.

If you decide to ask your GP for a prescription, you might mention to her or him that the reason why you need to change, is because the Entocort tends to increase your blood pressure. We have found that most GPs seem to be more compassionate, and more concerned about their patients' health, than most GI specialists. Whatever you decide to do, I wish you the best of luck with this.

You're most welcome,
Tex

[tired of it all]

Thanks so much for the info Tex. I will call my GP tomorrow regarding the mesalamine drugs. I have never heard of them before. So there you go; that's why this forum is so beneficial to people like me I too feel that the GP's are more understanding in some ways with their patients.

I'm making a trip to the Food Co-Op here in Roanoke in a little while to seek out gluten free things, especially bread. If I have to bake it myself I will!

You're so right about everyone being different regarding certain meds. I am extremely sensitive to all antibiotics, etc, so I'm sure that I respond more so than the "average" person does to each & every medication. So many times, I've had to take half of what a MD orders in order to maintain my well being. We know our bodies I believe, better than anyone else

Again thanks so much!

[tex]

We know our bodies I believe, better than anyone else

Truer words were never spoken, (or written).

Good luck on the shopping trip. Most people find that Udi's GF bread is far superior to the other brands available, if you can find it in your area. Most GF bread is shipped frozen, but I'm not sure how Udi's is sold, since the stores around here don't carry it yet. You may have to ask, if you don't see it.

http://udisfood.com/

Tex

[hoosier1]

Rudi's gluten free bread, I find, is even tastier than Udi's. Anyone try this brand yet?

[tired of it all]

Thanks again Tex. I did find quite a few things at the Co-Op; including the Udi's bread, so I am a happy camper for the moment Also had a Larabar blueberry bar on the way home. It was yum!

I will keep you & all informed as to what happens with my GP.

Thanks to you too Hoosier 1. Will keep my eye out for the Rudi's bread.

Karen

[sarkin]

Karen.... did you say BLUEBERRY LARABAR???

Totally changing my itinerary tomorrow to make one of those happen!

Thanks,
Sara