Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca; Cluj County Clinical Emergency Hospital, 3rd Department of Internal Medicine Cluj-Napoca, Romania.
Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.
J Gastrointestin Liver Dis. 2023 Dec 22;32(4):469-472. doi: 10.15403/jgld-5025.
Irritable Bowel Syndrome (IBS) is one of the most frequently diagnosed gastrointestinal disease with a prevalence of 4.1% in the general population. It is diagnosed using the Rome IV criteria. Microscopic colitis (MC), collagenous/lymphocytic colitis is a cause of chronic, watery, non-bloody diarrhea. It is a real challenge to diagnose MC in patients with IBS. The aims of the study were to determine the prevalence of MC in patients initially diagnosed with IBS, as well as to correlate fecal calprotectin levels with the endoscopic findings and microscopic inflammation in MC.
This is a retrospective study conducted in a single tertiary center with over 89 IBS patients for a period of 4 years. The patients included were patients diagnosed with IBS predominant diarrhea (IBS-D) and mixed IBS (IBS-M) using the Rome IV criteria. Total colonoscopy was performed in these patients, multiple biopsies being taken and calprotectin levels were measured.
Out of a total of 89 IBS-D patients, 58 patients (65.2%) had no microscopic lesions, 12 patients (13.5%) had diverticular disease, 9 patients (10.1%) had non-specific chronic inflammation of the colon mucosa and 10 patients (11.2%) were diagnosed with MC. The calprotectin levels ranged from 49 μg/g to 213 μg/g. Of a total of 10 patients diagnosed with MC, 6 (60%) of them had calprotectin levels <100 μg/g and 4 (40%) had calprotectin levels >100 μg/g. The fecal calprotectin levels were higher in patients diagnosed with MC compared to those who had no microscopic lesions at the histological exam and it was also correlated with the grade of colonic microscopic inflammation.
Microscopic colitis is less familiar to physicians and can be clinically misdiagnosed as IBS-D. An early and correct diagnosis is important for an accurate therapy.
肠易激综合征（IBS）是最常见的胃肠道疾病之一，普通人群患病率为 4.1%。其诊断标准采用罗马 IV 标准。显微镜下结肠炎（MC），胶原性/淋巴细胞性结肠炎是慢性、水样、非血性腹泻的原因。在 IBS 患者中诊断 MC 具有挑战性。本研究的目的是确定最初诊断为 IBS 的患者中 MC 的患病率，并将粪便钙卫蛋白水平与 MC 的内镜表现和显微镜下炎症相关联。
这是一项在一家三级中心进行的回顾性研究，共纳入 89 例 IBS 患者，研究时间为 4 年。这些患者包括符合罗马 IV 标准的 IBS 腹泻型（IBS-D）和混合性 IBS（IBS-M）患者。对这些患者进行全结肠镜检查，取多处活检，并测量钙卫蛋白水平。
在总共 89 例 IBS-D 患者中，58 例（65.2%）无显微镜下病变，12 例（13.5%）有憩室病，9 例（10.1%）有非特异性结肠黏膜慢性炎症，10 例（11.2%）诊断为 MC。钙卫蛋白水平为 49μg/g 至 213μg/g。在总共 10 例诊断为 MC 的患者中，6 例（60%）的钙卫蛋白水平<100μg/g，4 例（40%）的钙卫蛋白水平>100μg/g。与组织学检查无显微镜下病变的患者相比，诊断为 MC 的患者粪便钙卫蛋白水平更高，且与结肠显微镜下炎症程度相关。
MC 对医生来说不太熟悉，可能会被临床误诊为 IBS-D。早期正确的诊断对准确的治疗很重要。
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