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No increased prevalence of microscopic colitis found in patients with IBS symptoms
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Although a third of patients with microscopic colitis experienced symptoms that overlap with irritable bowel syndrome, researchers did not observe increased prevalence of microscopic colitis among irritable bowel syndrome patients vs. other patients with diarrhea undergoing colonoscopy, according to the results of a meta-analysis.
“Microscopic colitis and IBS ... may share similar presenting symptoms and in both conditions the mucosa at colonoscopy is normal,” Alexander C. Ford, MD, FRCP, from the Leeds Gastroenterology Institute, St. James University Hospital, and the Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, in the U.K., and colleagues wrote. “Treatment options for these conditions are quite different, therefore making a prompt diagnosis of MC has important management implications.”
Alexander C. Ford
Ford and colleagues therefore sought to determine the prevalence of IBS in patients with histologically confirmed MC and vice versa. They searched relevant literature for cross-sectional surveys or case-control studies, included 10 in their analysis, pooled data using a random-effects model and calculated odds ratios for associations between MC and IBS.
The pooled prevalence of IBS in patients with MC was 33.4% (95% CI, 31.5-40.6), but it was not significantly higher in patients with MC vs. those without MC (OR = 1.39; 95% CI, 0.43-4.47).
In three cross-sectional surveys, the pooled OR for MC in patients with IBS vs. those without IBS was 0.68 (95% CI, 0.44-1.04). In four case-control studies, the OR for MC among patients with IBS vs. patients without IBS was 5.16 (95% CI, 1.32-20.2).
These data “show that one in three patients with MC report IBS symptoms, but IBS symptoms were not more common in patients with MC compared with individuals without MC,” the researchers concluded. “Case-control studies showed a significantly higher prevalence of MC among patients with IBS, compared with asymptomatic individuals, but in cross-sectional surveys there was no significant difference in the prevalence of MC in patients with IBS compared with patients with diarrhea undergoing colonoscopy. Based on current evidence the utility of colonoscopy and random biopsies to exclude MC in patients presenting with typical symptoms of IBS, in the absence of known risk factors for MC or alarm features, is debatable.”
Eamonn M. M. Quigley
“In these days of cost containment clinicians are inevitably reminded that colonoscopy provides a low diagnostic yield, yet incurs significant cost, in the evaluation of IBS,” Vineet S. Gudsoorkar, MD, and Eamonn M. M. Quigley, MD, FRCP, FACP, MACG, FRCPI, both from the Lynda K. and David M. Center for Digestive Disorders, division of gastroenterology and hepatology, Houston Methodist Hospital, Weill Cornell Medical College, Houston, Texas, wrote in a related editorial. “Now Kamp et al pour some more cold water on the use of colonoscopy and random biopsies in MC. Although conceding that more studies are required ‘before any firm conclusions can be drawn’ they suggest, based on their analyses, that the utility of this much honored diagnostic approach is ‘debatable’; hardly a rousing endorsement.” Whether clinicians should reconsider this diagnostic strategy ultimately depends on context, they wrote. – by Adam Leitenberger
Disclosure: The researchers and editorial authors report no relevant financial disclosures.
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