Undiagnosed microscopic colitis: a hidden cause of chronic diarrhoea and a frequently missed treatment opportunity.

Autor:	Münch A; Division of Gastroenterology and Hepatology, Department of Clinical and Experimental Medicine, Faculty of Health Science, Linköping University, Linköping, Sweden., Sanders DS; Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK., Molloy-Bland M; Oxford PharmaGenesis, Melbourne, Victoria, Australia., Hungin APS; The Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.
Jazyk:	angličtina
Zdroj:	Frontline gastroenterology [Frontline Gastroenterol] 2019 Jul 05; Vol. 11 (3), pp. 228-234. Date of Electronic Publication: 2019 Jul 05 (Print Publication: 2020).
DOI:	10.1136/flgastro-2019-101227
Abstrakt:	Microscopic colitis (MC) is a treatable cause of chronic, non-bloody, watery diarrhoea, but physicians (particularly in primary care) are less familiar with MC than with other causes of chronic diarrhoea. The colon in patients with MC is usually macroscopically normal. MC can only be diagnosed by histological examination of colonic biopsies (subepithelial collagen band >10 µm (collagenous colitis) or >20 intraepithelial lymphocytes per 100 epithelial cells (lymphocytic colitis), both with lamina propria inflammation). The UK National Health Service exerts downward pressure to minimise colonoscopy referrals. Furthermore, biopsies are often not taken according to guidelines. These factors work against MC diagnosis. In this review, we note the high incidence of MC (comparable to ulcerative colitis and Crohn's disease) and its symptomatic overlap with irritable bowel syndrome. We also highlight problems with the recommendation by National Health Service/National Institute for Health and Care Excellence guidelines for inflammatory bowel diseases that colonoscopy referrals should be based on a faecal calprotectin level of ≥100 µg/g. Faecal calprotectin is <100 µg/g in over half of individuals with active MC, building into the system a propensity to misdiagnose MC as irritable bowel syndrome. This raises important questions-how many patients with MC have already been misdiagnosed, and how do we address this silent burden? Clarity is needed around pathways for MC management; MC is poorly acknowledged by the UK healthcare system and it is unlikely that best practices are being followed adequately. There is an opportunity to identify and treat patients with MC more effectively. Competing Interests: Competing interests: MM-B is an independent contractor for Oxford PharmaGenesis, Melbourne, Australia, which received funding for this study from Tillotts Pharma, the manufacturer of budesonide (used to treat patients with microscopic colitis). AM has received honoraria for consultancy, and speaker fees and research grants from Vifor Pharma, Tillotts Pharma, Dr Falk Pharma and Ferring Pharmaceuticals. DSS has received educational grants from Tillotts Pharma for investigator-led research into coeliac disease and microscopic colitis. APSH has served on advisory boards and received funding from Allergan, Shire (now part of Takeda), Tillotts Pharma and Danone within the last 3 years. (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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