Microscopic Colitis or Functional Bowel Disease With Diarrhea: A French Prospective Multicenter Study

Abstract

Age >50 years, the presence of nocturnal stools, weight loss, the introduction of a new drug, and the presence of a known autoimmune disease increase the probability of MC and thus the indication for colonoscopy with biopsies.

Irritable Bowel Syndrome and Microscopic Colitis: A Systematic Review and Meta-analysis

“…In a large multicenter prospective study, conducted in France, reporting the characteristics of a cohort of patients with MC, and comparing their characteristics with those of patients with IBS-D or other functional bowel disorders with diarrhea, age ≥50 years, coexistent autoimmune disease, female gender, medications such as proton pump inhibitors or nonsteroidal anti-inflammatory drugs, presence of weight loss, longer duration of diarrhea, and nocturnal symptoms were all associated with MC. 56 Performing a receiver operating characteristics curve analysis using these data demonstrated an area under the curve of 0.80, and identified that if the presence of two or more risk factors was used to decide whether or not to obtain random colonic biopsies, sensitivity to detect MC was 93.5%, but random colonic biopsies were avoided in 47.8% of patients with diarrhea. 57 In a similar study Kane et al.…”

Enhancing Diagnostic Performance of Symptom-Based Criteria for Irritable Bowel Syndrome by Additional History and Limited Diagnostic Evaluation

“…Interestingly, studies using combinations of symptoms with biomarkers and/or measures of psychological wellbeing reported improved diagnostic accuracy. 17,21 Other investigators have reported that the absence of "red flag" features, such as nocturnal symptoms, 22,23 or incorporating the results of simple laboratory tests, including hemoglobin and erythrocyte sedimentation rate, 24 may increase the ability to distinguish between functional and organic lower GI diseases.…”

Point of Care Ultrasound Accurately Distinguishes Inflammatory from Non Inflammatory Disease in Patients Presenting with Abdominal Pain and Diarrhea

“…In this study, 83% (48/58) of patients had no evidence of inflammation on POCUS or endoscopy, suggesting that ultrasound may obviate the need for endoscopy in select patients, especially in combination with a low CRP, as recent evidence suggests that CRP < 1.0 makes the probability of IBD very low [9]. Clinical factors suggesting organic etiology including MC may also be useful, such as night time stooling, weight loss, and age greater than 50 years [27]. In this study, CRP was not suggestive of more severe disease either sonographically or endoscopically, illustrating, even in this small sample, limitations with using CRP as a guide for the need for endoscopy.…”