| Irritable Bowel Syndrome (IBS) and Microscopic | | | | often effective. |
| Colitis Symptoms Overlap | | | | EARLY FINDINGS OF INTESTINAL |
| Symptoms of IBS and microscopic colitis overlap. | | | | INFLAMMATION OFTEN CONSISTS ONLY OF |
| In a group of biopsy proven microscopic colitis | | | | INCREASED CELLS, SOMETIMES ONLY SEEN |
| patients, there is noted that up to half have | | | | WITH SPECIAL STAINS |
| symptoms that meet diagnostic criteria for | | | | The earliest intestinal biopsy findings of Celiac |
| Irritable Bowel Syndrome (IBS). Microscopic colitis | | | | disease and microscopic colitis is increased number |
| is diagnosed only by biopsies of the colon even | | | | of lymphocytes per 100 epithelial (intestinal lining) |
| when it appears normal. Symptom-based criteria | | | | cells. In the colon intraepithelial lymphocytosis is |
| for diagnosing IBS are not specific enough to rule | | | | considered diagnostic for microscopic colitis if 20 |
| out microscopic colitis. Some people with IBS have | | | | or more lymphocytes per 100 epithelial cells are |
| Mastocytic Enterocolitis, a newly recognized form | | | | found. Interestingly the criteria for abnormal |
| of microscopic colitis characterized by increased | | | | intraepithelial lymphocytosis in Celiac disease has |
| numbers of mast cells in the intestinal lining. These | | | | more recently been reduced from 40 IELs per |
| cells can only be seen when special stains are | | | | 100 utilized for nearly thirty years to 30 per 100. |
| applied to intestinal biopsies, a maneuver, not | | | | Even more recent studies have indicated that this |
| usually done by most pathologists or requested | | | | should be reduced further to 20-25 per 100 |
| by most doctors performing intestinal biopsies. | | | | because it is noted that early gluten injury occurs |
| PATIENTS WITH IBS SHOULD UNDERGO | | | | with lower levels of lymphocytes in the intestinal |
| COLONOSCOPY WITH BIOPSIES OF NORMAL | | | | lining and is associated with a favorable response |
| APPEARING INTESTINAL LINING | | | | to gluten free diet. Microscopic colitis frequently |
| Patients suspected to have irritable bowel | | | | responds favorably to a gluten-free diet. |
| syndrome should undergo biopsies of the colon. | | | | DON'T HAVE YOUR DIAGNOSIS MISSED BY |
| This is absolutely necessary to exclude the | | | | FAILURE TO GET AN INTESTINAL BIOPSY AND |
| possibility that they could have one of several | | | | BLOOD TESTS BEFORE ACCEPTING IBS |
| forms of microscopic colitis. The diagnosis of | | | | Numerous patients have come to me with a |
| microscopic colitis is made when biopsies of the | | | | diagnosis of IBS for years who I have confirmed |
| colon have an increase in infection fighting or | | | | to have Celiac disease, microscopic colitis or |
| immune cells or deposits of excess collagen | | | | non-celiac gluten sensitivity. These patients |
| connective tissue in the lining of the digestive | | | | typically respond dramatically to a gluten free diet |
| tract. In the most common form of microscopic | | | | even in the absence of a diagnosis of Celiac |
| colitis seen without special stains, excess | | | | disease. Several of my patients have both Celiac |
| lymphocyte white blood cells, or so called | | | | disease and a form of microscopic colitis such as |
| "intraepithelial lymphocytosis", seen under the | | | | lymphocytic or collagenous colitis. |
| microscope. This microscopic finding is present | | | | UNNECESSARY DELAYS IN DIAGNOSIS AND |
| when the colon looks normal on the surface. Many | | | | SUFFERING NOT NECESSARY IF YOU BECOME |
| doctors don't biopsy the colon when it looks | | | | YOUR OWN ADVOCATE |
| normal despite obtaining a history of diarrhea | | | | People often experience years of unnecessary |
| from the patient. Microscopic colitis is a known | | | | suffering due to delays in diagnosis of Celiac |
| treatable cause of diarrhea, bloating, gas and | | | | disease, microscopic colitis, Mastocytic |
| abdominal pain that can only be diagnosed by | | | | Enterocolitis, Crohn's disease, and food intolerance. |
| colon biopsies. In many patients who do get | | | | Many developed preventable secondary |
| biopsies, special stains are not ordered when the | | | | complications such as osteoporosis, infertility, iron |
| standard stains fail to reveal an abnormality. | | | | deficiency or autoimmune diseases. Most live for |
| However, under special stains, excess mast cells | | | | years with pain, stomach pains, and diarrhea under |
| may be seen and a diagnosis of a treatable form | | | | the false conclusion that they have IBS. Frustation |
| of IBS known as mastocytic enterocolitis is | | | | occurs when you are told there is little to nothing |
| missed. | | | | that can be done besides taking anti-diarrhea and |
| BLOOD TESTS SHOULD ALSO BE DONE BEFORE | | | | anti-spasm medications combined with a high fiber |
| ASSUMING A DIAGNOSIS OF IBS | | | | diet and fiber supplements. Yet, most note they |
| Blood tests should be done to screen for Celiac | | | | are no better or even worse with increased fiber. |
| disease, ulcerative colitis and Crohn's disease. | | | | If you have complained to your doctor that such |
| Without these blood tests and intestinal biopsies, | | | | agents seem to cause more severe bloating, gas, |
| Celiac disease, Crohn's disease and various forms | | | | diarrhea and abdominal pain you are often scoffed |
| of colitis especially microscopic colitis are | | | | at or told you are not being compliant. Little did |
| frequently missed. | | | | you or your doctor know that increasing fiber |
| MULTIPLE BIOPSIES SHOULD BE DONE TO | | | | intake can make you worse if you are gluten |
| AVOID MISSING PATCHY AREAS OF | | | | intolerant. |
| INVOLVEMENT | | | | GLUTEN FREE DIET MAY HELP SYMPTOMS OF |
| Microscopic irritation or inflammation of the | | | | IBS AND SHOULD BE TRIED AFTER GETTING |
| intestine can be patchy. Therefore, anyone | | | | TESTED FOR CELIAC DISEASE FIRST |
| undergoing colonoscopy or upper endoscopy with | | | | Don't accept a diagnosis of IBS without adequate |
| symptoms, especially diarrhea, bloating, gas or | | | | diagnostic testing or consideration of a trial of |
| abdominal pain, should have multiple intestinal | | | | gluten free diet. Before accepting IBS learn more |
| biopsies. Inflammation that is the cause of these | | | | about the various forms of colitis, Celiac disease, |
| symptoms is often only seen microscopically and | | | | non-celiac gluten sensitivity, Crohn's disease and |
| may be patchy. However, once a diagnosis is | | | | altered gut flora and be your own advocate when |
| made treatment with medications and/or diet is | | | | you visit your doctor. |