Original article
Alimentary tract
Development and Validation of a Scoring System to Identify Patients With Microscopic Colitis

https://doi.org/10.1016/j.cgh.2014.12.035Get rights and content

Background & Aims

Diarrhea is a common indication for colonoscopy. Biopsies are collected and analyzed from patients with a macroscopically normal colon to exclude microscopic colitis (MC), but the diagnostic yield is low because most patients have functional disease. We developed and validated a diagnostic scoring system to identify patients with MC to reduce the need to collect biopsies from all patients.

Methods

We performed a retrospective study, which analyzed demographic and symptom data from adult patients with chronic diarrhea evaluated by colonoscopy and biopsy at 3 endoscopy centers in Leeds, United Kingdom. To derive the scoring system, we analyzed data from 476 adult patients (mean age, 53.6 years; 63.7% female) examined in 2011. Factors significantly associated with the presence of MC were assigned item scores, and total scores were determined for each patient. To validate the system, we used it to assess data from 460 patients (mean age, 52.9 years; 59.8% female) examined in 2012. The primary aim of the study was to determine the performance of the diagnostic scoring system in identifying patients with MC by using histologic findings as a reference.

Results

In the derivation cohort, 85 patients were diagnosed with MC on the basis of histologic analysis. Age ≥50 years, female sex, use of proton pump inhibitors or nonsteroidal anti-inflammatory drugs, weight loss, and absence of abdominal pain were significantly associated with MC. We created a scoring system for diagnosis of MC, with scores ranging from –8 to +38; scores ≥8 were used to identify the presence of MC. This cutoff value identified patients with MC in the validation cohort (74 patients, 16.1%) with 90.5% sensitivity and 45.3% specificity (area under the receiver operating characteristic curve value, 0.76). Because of its ability to exclude MC and therefore avoid the need for routine collection of colonic biopsies, this scoring system reduced the cost of evaluation by >£7000 in the cohort.

Conclusions

We collected data on risk factors for MC to create a scoring system that identifies patients with MC with more than 90% sensitivity. This system can also reduce costs by identifying patients who are unlikely to have MC who do not require biopsy analysis.

Section snippets

Participants and Setting

The study was conducted among individuals with chronic diarrhea referred for colonoscopy at the endoscopy units in Leeds Teaching Hospitals National Health Service Trust, West Yorkshire during a 2-year period between 2011 and 2012. There are 3 endoscopy units at Leeds General Infirmary, St James’s University Hospital, and Wharfedale General Hospital, which are staffed by the same team and follow identical clinical protocols. The hospitals provide secondary care services to a local population of

Derivation Cohort

In total, 476 of 2151 patients (22.1%) with chronic diarrhea undergoing complete colonoscopy with random colonic biopsies from 2011 were included in the derivation cohort. The mean age of these individuals was 53.6 years (range, 17–91 years), and 303 (63.7%) were female. Of the included subjects, 85 patients (17.9%) were diagnosed with MC on histologic grounds, 67 with collagenous colitis and 18 with lymphocytic colitis. The remaining 391 patients had a macroscopically normal colonoscopy and

Discussion

This study was designed to derive and validate a novel diagnostic scoring system to distinguish patients with MC from those with functional bowel disease on the basis of clinical data, which can easily be collected and implemented when taking a history from the patient. In our derivation cohort, factors associated with MC included female gender, age 50 years and older, NSAID or PPI use, presence of weight loss, and absence of abdominal pain. When these were combined in our diagnostic scoring

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    Conflicts of interest The authors disclose no conflicts.

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