SYSTEMATIC REVIEWS AND META-ANALYSES Fasiha Kanwal, Section Editor Irritable Bowel Syndrome and Microscopic Colitis: A Systematic Review and Meta-analysis Eline J. C. A. Kamp, * John S. Kane, ‡,§ and Alexander C. Ford ‡,§ *Radboud University Medical Centre, Radboud University, Nijmegen, The Netherlands; ‡ Leeds Gastroenterology Institute, St. James’s University Hospital, Leeds, United Kingdom; § Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, United Kingdom This article has an accompanying continuing medical education activity on page e55. Learning Objective–Upon completion of this activity, suc- cessful learners should be able to recognize the relevance of microscopic colitis as a differential diagnosis for patients with symptoms compatible with irritable bowel syndrome. BACKGROUND & AIMS: Patients with microscopic colitis and patients 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 or more 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 diar- rhea (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 the 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 in other patients with diarrhea. The odds of microscopic colitis were no higher in patients with IBS compared with other patients with diarrhea. The value of routine colonoscopy and biopsy to exclude micro- scopic colitis in patients with typical IBS symptoms, unless other risk factors or alarm symp- toms are present, remains uncertain. Keywords: Collagenous Colitis; Lymphocytic Colitis; Abdominal Pain; Inflammation. See editorial on page 669. I rritable bowel syndrome (IBS) is a chronic func- tional disorder of the gastrointestinal (GI) tract characterized by abdominal pain or discomfort and altered bowel habit. 1 It is one of the most commonly diagnosed functional GI disorders, affecting approxi- mately 10% of the general population, 2 and with a female predominance in most studies. 3 The condition can be associated with significant emotional distress, impaired health-related quality of life, disability, and high health care costs. 4–7 No known structural or anatomic explanation accounts for the pathophysiology of IBS, although several mechanisms have been proposed, including low-grade mucosal inflammation, visceral hy- persensitivity, alterations in fecal flora, and bacterial overgrowth. 8–11 Abbreviations used in this paper: CC, collagenous colitis; CI, confidence interval; GI, gastrointestinal; IBS, irritable bowel syndrome; IBS-D, diarrhea-predominant irritable bowel syndrome; LC, lymphocytic colitis; MC, microscopic colitis; OR, odds ratio. Most current article © 2016 by the AGA Institute 1542-3565/$36.00 http://dx.doi.org/10.1016/j.cgh.2015.09.031 Clinical Gastroenterology and Hepatology 2016;14:659–668
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