Abstract

Irritable Bowel Syndrome and Microscopic Colitis: a Systematic Review and Meta-analysis

Kamp EJ1, Kane JS2, Ford AC3. Clin Gastroenterol Hepatol. 2015 Oct 7. pii: S1542-3565(15)01333-6. doi: 10.1016/j.cgh.2015.09.031. [Epub ahead of print]
 
     
Author information

1Radboud UMC, Radboud University, Nijmegen, The Netherlands. 2Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK; Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK. 3Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK; Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK. Electronic address: alexf12399@yahoo.com.

Abstract

BACKGROUND: & Aims: Patients with microscopic colitis and those with irritable bowel syndrome (IBS) present with similar symptoms. We examined the association between IBS and microscopic colitis in a systematic review and meta-analysis.

METHODS: We searched the medical literature to identify cross-sectional surveys or case-control studies reporting the association between microscopic colitis and IBS in ≥50 unselected adult patients. We recorded the prevalence of IBS symptoms in patients with histologically confirmed microscopic colitis, or the prevalence of histologically confirmed microscopic colitis in patients with IBS. Data were pooled using a random effects model; the association between microscopic colitis and IBS was summarized using an odds ratio (OR) with a 95% confidence interval (CI).

RESULTS: The search strategy identified 3926 citations, of which 10 were eligible for our analysis. The pooled prevalence of IBS in patients with microscopic colitis was 33.4% (95% CI, 31.5%-40.6%), but was not significantly higher in patients with microscopic colitis than in patients with diarrhea (OR, 1.39; 95% CI, 0.43-4.47). In 3 cross-sectional surveys, the pooled OR for microscopic colitis in participants with IBS, compared with other patients with diarrhea, was 0.68 (95% CI, 0.44-1.04). In 4 case-control studies prevalence of IBS in patients with microscopic colitis was significantly higher than in asymptomatic controls (OR, 5.16; 95% CI, 1.32-20.2).

CONCLUSIONS: Based on a meta-analysis, one-third of patients with microscopic colitis reported symptoms compatible with IBS, but the prevalence of IBS was no higher than other patients with diarrhea. Odds of microscopic colitis were no higher in patients with IBS compared to other patients with diarrhea. The value of routine colonoscopy and biopsy to exclude microscopic colitis in patients with typical IBS symptoms, unless other risk factors or alarm symptoms are present, remains uncertain.

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