Your Irritable Bowel Syndrome (IBS) May Be Misdiagnosed Or Be Undiagnosed Colitis
Irritable Bowel Syndrome (IBS) and Microscopic Colitis Symptoms Overlap
Symptoms of IBS and microscopic colitis overlap. In a group of biopsy proven microscopic colitis Medical Education patients, there is noted that up to half have symptoms that meet diagnostic criteria for Irritable Bowel Syndrome (IBS). Microscopic colitis is diagnosed only by biopsies of the colon even when it appears normal. Symptom-based criteria for diagnosing IBS are not specific enough to rule out microscopic colitis. Some people with IBS have Mastocytic Enterocolitis, a newly recognized form of microscopic colitis characterized by increased numbers of mast cells in the intestinal lining. These cells can only be seen when special stains are applied to intestinal biopsies, a maneuver, not usually done by most pathologists or requested by most doctors performing intestinal biopsies.
PATIENTS WITH IBS SHOULD UNDERGO COLONOSCOPY WITH BIOPSIES OF NORMAL APPEARING INTESTINAL LINING
Patients suspected to have irritable bowel syndrome should undergo biopsies of the colon. This is absolutely necessary to exclude the possibility that they could have one of several forms of microscopic colitis. The diagnosis of microscopic colitis is made when biopsies of the colon have an increase in infection fighting or immune cells or deposits of excess collagen connective tissue in the lining of the digestive tract. In the most common form of microscopic colitis seen without special stains, excess lymphocyte white blood cells, or so called “intraepithelial lymphocytosis”, seen under the microscope. This microscopic finding is present when the colon looks normal on the surface. Many doctors don’t biopsy the colon when it looks normal despite obtaining a history of diarrhea from the patient. Microscopic colitis is a known treatable cause of diarrhea, bloating, gas and abdominal pain that can only be diagnosed by colon biopsies. In many patients who do get biopsies, special stains are not ordered when the standard stains fail to reveal an abnormality. However, under special stains, excess mast cells may be seen and a diagnosis of a treatable form of IBS known as mastocytic enterocolitis is missed.
BLOOD TESTS SHOULD ALSO BE DONE BEFORE ASSUMING A DIAGNOSIS OF IBS
Blood tests should be done to screen for Celiac disease, ulcerative colitis and Crohn’s disease. Without these blood tests and intestinal biopsies, Celiac disease, Crohn’s disease and various forms of colitis especially microscopic colitis are frequently missed.
MULTIPLE BIOPSIES SHOULD BE DONE TO AVOID MISSING PATCHY AREAS OF INVOLVEMENT
Microscopic irritation or inflammation of the intestine can be patchy. Therefore, anyone undergoing colonoscopy or upper endoscopy with symptoms, especially diarrhea, bloating, gas or abdominal pain, should have multiple intestinal biopsies. Inflammation that is the cause of these symptoms is often only seen microscopically and may be patchy. However, once a diagnosis is made treatment with medications and/or diet is often effective.
EARLY FINDINGS OF INTESTINAL INFLAMMATION OFTEN CONSISTS ONLY OF INCREASED CELLS, SOMETIMES ONLY SEEN WITH SPECIAL STAINS