Article Text
Abstract
Microscopic colitis (MC) is a treatable cause of chronic, non-bloody, watery diarrhoea, but physicians (particularly in primary care) are less familiar with MC than with other causes of chronic diarrhoea. The colon in patients with MC is usually macroscopically normal. MC can only be diagnosed by histological examination of colonic biopsies (subepithelial collagen band >10 µm (collagenous colitis) or >20 intraepithelial lymphocytes per 100 epithelial cells (lymphocytic colitis), both with lamina propria inflammation). The UK National Health Service exerts downward pressure to minimise colonoscopy referrals. Furthermore, biopsies are often not taken according to guidelines. These factors work against MC diagnosis. In this review, we note the high incidence of MC (comparable to ulcerative colitis and Crohn’s disease) and its symptomatic overlap with irritable bowel syndrome. We also highlight problems with the recommendation by National Health Service/National Institute for Health and Care Excellence guidelines for inflammatory bowel diseases that colonoscopy referrals should be based on a faecal calprotectin level of ≥100 µg/g. Faecal calprotectin is <100 µg/g in over half of individuals with active MC, building into the system a propensity to misdiagnose MC as irritable bowel syndrome. This raises important questions—how many patients with MC have already been misdiagnosed, and how do we address this silent burden? Clarity is needed around pathways for MC management; MC is poorly acknowledged by the UK healthcare system and it is unlikely that best practices are being followed adequately. There is an opportunity to identify and treat patients with MC more effectively.
- inflammatory bowel disease
- collagenous colitis
- lymphocytic colitis
- colonoscopy
- histopathology
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Footnotes
Contributors AM and DSS contributed to the study concept, provided relevant literature and reviewed and revised the manuscript for important intellectual content. MM-B performed literature searches, drafted the manuscript and provided editorial support. APSH contributed to the study concept and reviewed and revised the manuscript for important intellectual content. All authors read and approved the final manuscript version for submission.
Funding Funding for the study was provided by Tillotts Pharma, the manufacturer of budesonide, which is used to treat patients with microscopic colitis.
Competing interests MM-B is an independent contractor for Oxford PharmaGenesis, Melbourne, Australia, which received funding for this study from Tillotts Pharma, the manufacturer of budesonide (used to treat patients with microscopic colitis). AM has received honoraria for consultancy, and speaker fees and research grants from Vifor Pharma, Tillotts Pharma, Dr Falk Pharma and Ferring Pharmaceuticals. DSS has received educational grants from Tillotts Pharma for investigator-led research into coeliac disease and microscopic colitis. APSH has served on advisory boards and received funding from Allergan, Shire (now part of Takeda), Tillotts Pharma and Danone within the last 3 years.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
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