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Open Access Research article

Low prevalence of ‘classical’ microscopic colitis but evidence of microscopic inflammation in Asian Irritable Bowel Syndrome patients with diarrhoea

Ida Hilmi1*, Juanda Leo Hartono1, Jayalakshmi Pailoor2, Sanjiv Mahadeva1 and Khean-Lee Goh1

Author Affiliations

1 Gastroenterology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

2 Department of Pathology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

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BMC Gastroenterology 2013, 13:80  doi:10.1186/1471-230X-13-80

Published: 8 May 2013

Abstract

Background

There is increasing evidence for the role of microscopic inflammation in patients with IBS. We aimed to examine the prevalence of microscopic colitis and inflammation in Malaysian IBS patients with diarrhoea (IBS-D).

Methods

Consecutive patients who met the Rome III criteria for IBS-D and asymptomatic controls were prospectively recruited. Colonoscopy was performed in all study subjects and systematic biopsies taken from all segments of the colon. The diagnosis of lymphocytic colitis and collagenous colitis was made using previously defined criteria. Patients with post infectious IBS were excluded.

Results

120 subjects (74 IBS-D, 46 controls) were recruited during the study period. In the IBS-D group, the colonoscopic (macroscopic) findings were as follows; normal findings n = 58 (78.4%), diverticula disease n = 5 (6.8%), diminutive polyps n = 9 (12.2%) and haemorrhoids n = 2(2.7%). No subject under the age of 40 had any significant findings. Microscopically, there was only one case (1.3%) with histology consistent with collagenous colitis. However, the IBS-D patients had a higher prevalence of moderate microscopic inflammation (n = 11, 14.9%) compared to controls (n = 1, 2.2%) (p = 0.005).

Conclusions

‘Classical’ microscopic colitis is uncommon in Malaysian patients with IBS-D but a significant number of adults showed evidence of microscopic inflammation.