High prevalence of irritable bowel syndrome-type symptoms in microscopic colitis: implications for treatment

Kane, John S; Irvine, Andrew J; Derwa, Y.; Rotimi, Olorunda; Ford, Alexander C

doi:10.1177/1756284818783600

Cited by 8 publications

(9 citation statements)

References 43 publications

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“…In a case‐control study including 212 MC patients, all four HRQoL dimensions (symptom burden, social function, disease‐related worry, general well‐being) were impaired in patients with active CC and LC 184 . In a cross‐sectional survey of 151 MC patients, 52 (34.4%) reported IBS‐type symptoms and had higher levels of anxiety, depression and somatisation and impaired quality of life 179 . In another cross‐sectional survey of 129 patients with a new diagnosis of MC, fatigue severity resulted to be associated with IBS‐type symptoms, psychological comorbidity and impaired quality of life, with a negative correlation in HRQoL measures 188 .…”

Section: Methodsmentioning

confidence: 97%

“…Summary of available evidence: MC shares similar symptoms and endoscopic results with functional bowel disorders, especially in diarrhoea‐dominant IBS and chronic functional diarrhoea 176–179 . In two meta‐analyses, the identification of underlying MC diagnosis was reported in 9% (95% CI: 4.5%–14.9%) among patients exhibiting diarrhoea‐predominant functional disorders 176,178 .…”

Section: Methodsmentioning

confidence: 99%

“…184 In a cross-sectional survey of 151 MC patients, 52 (34.4%) reported IBS-type symptoms and had higher levels of anxiety, depression and somatisation, and impaired quality of life. 179 In another cross-sectional survey of 129 patients with a new diagnosis of MC, fatigue severity resulted to be associated with IBStype symptoms, psychological comorbidity and impaired quality of life, with a negative correlation in HRQoL measures. 188 In a cross-sectional study including 158 female MC patients, those with coexisting IBSlike symptoms (55%) experienced worse psychological well-being than those without.…”

Section: Very Lowmentioning

confidence: 97%

“…LE: moderate; GR: NA; agreement: 93%, consensus Summary of available evidence: MC shares similar symptoms and endoscopic results with functional bowel disorders, especially in diarrhoea-dominant irritable bowel syndrome and chronic functional diarrhoea. [176][177][178][179] In two meta-analyses, the identification of underlying MC diagnosis was reported in 9% (95% CI: 4.5-14.9%) among patients exhibiting diarrhoea-predominant functional disorders. 176,178 However, not all studies employed the currently accepted diagnostic criteria for MC, and different criteria for defining functional bowel disorders were used, contributing to the high heterogeneity of the results.…”

Section: Very Lowmentioning

confidence: 99%

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European guidelines on microscopic colitis: United European Gastroenterology and European Microscopic Colitis Group statements and recommendations

et al. 2021

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Introduction Microscopic colitis is a chronic inflammatory bowel disease characterised by normal or almost normal endoscopic appearance of the colon, chronic watery, non-bloody diarrhoea and distinct histological abnormalities, which identify three histological subtypes, the collagenous colitis, the lymphocytic colitis and the incomplete microscopic colitis. With ongoing uncertainties and new developments in the clinical management of microscopic colitis, there is a need for evidence-based guidelines to improve the medical care of patients suffering from this disorder. Methods Guidelines were developed by members from the European Microscopic Colitis Group and United European Gastroenterology in accordance with the Appraisal of Guidelines for Research and Evaluation II instrument. Following a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation methodology was used to assess the certainty of the evidence. Statements and recommendations were developed by working groups consisting of gastroenterologists, pathologists and basic scientists, and voted upon using the Delphi method. Results These guidelines provide information on epidemiology and risk factors of microscopic colitis, as well as evidence-based statements and recommendations on diagnostic criteria and treatment options, including oral budesonide, bile acid binders, immunomodulators and biologics. Recommendations on the clinical management of microscopic colitis are provided based on evidence, expert opinion and best clinical practice. Conclusion These guidelines may support clinicians worldwide to improve the clinical management of patients with microscopic colitis.

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Section: Methodsmentioning

confidence: 97%

Section: Methodsmentioning

confidence: 99%

Section: Very Lowmentioning

confidence: 97%

Section: Very Lowmentioning

confidence: 99%

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European guidelines on microscopic colitis: United European Gastroenterology and European Microscopic Colitis Group statements and recommendations

et al. 2021

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“…Irritable bowel syndrome with diarrhea (IBS-D) is a common condition, affecting up to 1% of the population, characterized by frequent loose stools, abdominal cramps and urgency which considerably impair the quality of life. Clinical diagnosis requires the exclusion of a range of inflammatory conditions which closely mimic IBS-D, including microscopic colitis 1 and Crohn’s disease, as well as bile salt malabsorption which is recently recognized to account for approximately 1 in 4 of patients presenting with symptoms of IBS-D. 2 IBS-D can also develop after a bout of gastroenteritis, so-called post-infectious IBS (PI-IBS). 3 The risk of developing PI-IBS is increased by the presence of markers of severity such as fever and rectal bleeding, suggesting that the resulting immune activation is a key factor in IBS symptoms.…”

Section: Introductionmentioning

confidence: 99%

Colonic Gene Expression and Fecal Microbiota in Diarrhea-predominant Irritable Bowel Syndrome: Increased Toll-like Receptor 4 but Minimal Inflammation and no Response to Mesalazine

Jalanka

Lam

Bennett

et al. 2021

J Neurogastroenterol Motil

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Background/Aims Diarrhea-predominant irritable bowel syndrome (IBS-D) has been previously associated with evidence of immune activation and altered microbiota. Our aim is to assess the effect of the anti-inflammatory agent, mesalazine, on inflammatory gene expression and microbiota composition in IBS-D. Methods We studied a subset of patients (n = 43) from a previously published 12-week radomized placebo-controlled trial of mesalazine. Mucosal biopsies were assessed by immunohistochemistry and reverse transcription-polymerase chain reaction for a range of markers of inflammation, altered permeability, and sensory receptors including Toll-like receptors (TLRs) at randomization after treatment. All biopsy data were compared to 21 healthy controls. Patient’s stool microbiota composition was analysed through 16S ribosomal RNA sequencing. Results We found no evidence of increased immune activation compared to healthy controls. However, we did find increased expression of receptors in both sensory pathways and innate immune response including TLR4. Higher TLR4 expression was associated with greater urgency. TLR4 expression correlated strongly with the expression of the receptors bradykinin receptor B2, chemerin chemokine-like receptor 1, and transient receptor potential cation channel, subfamily A, member 1 as well as TLR4’s downstream adaptor myeloid differentiation factor 88. Mesalazine had minimal effect on either gene expression or microbiota composition. Conclusions Biopsies from a well-characterized IBS-D cohort showed no substantial inflammation. Mesalazine has little effect on gene expression and its previous reported effect on fecal microbiota associated with much greater inflammation found in inflammatory bowel diseases is likely secondary to reduced inflammation. Increased expression of TLR4 and correlated receptors in IBS may mediate a general increase in sensitivity to external stimuli, particularly those that signal via the TLR system.

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Insights into the underlying mechanisms and clinical management of microscopic colitis in relation to other gastrointestinal disorders

Liu

Chen

2022

Gastroenterology Report

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Microscopic colitis (MC) is a chronic inflammatory disease of the large intestine and as a relatively late recognized condition, its relationship with other disorders of the gastrointestinal tract is gradually being understood and investigated. As a multifactorial disease, MC interacts with inflammatory bowel disease, celiac disease, and irritable bowel syndrome through genetic overlap, immunological factors, and gut microflora. The risk of colorectal cancer was significantly lower in MC, gastrointestinal infections increased the risk of developing MC, and there was an inverse association between Helicobacter pylori infection and MC. A variety of associations are found between MC and other gastrointestinal disorders, where aspects such as genetic effects, resemblance of immunological profiles, and intestinal microecology are potential mechanisms behind the relationships. Clinicians should be aware of these connections to achieve a better understanding and management of MC.

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High prevalence of irritable bowel syndrome-type symptoms in microscopic colitis: implications for treatment

Cited by 8 publications

References 43 publications

European guidelines on microscopic colitis: United European Gastroenterology and European Microscopic Colitis Group statements and recommendations

European guidelines on microscopic colitis: United European Gastroenterology and European Microscopic Colitis Group statements and recommendations

Colonic Gene Expression and Fecal Microbiota in Diarrhea-predominant Irritable Bowel Syndrome: Increased Toll-like Receptor 4 but Minimal Inflammation and no Response to Mesalazine

Insights into the underlying mechanisms and clinical management of microscopic colitis in relation to other gastrointestinal disorders

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