The principal clinical manifestation of microscopic colitides is diarrhea. On the basis of the nature of the inflammatory infiltrate and the thickness of the sub-mucosal collagen band, the microscopic colitides can be broadly separated into two entities, lymphocytic colitis and collagenous colitis ( 8, 9). The microscopic colitides are characterized by normal endoscopic appearance of the colon but an intense mucosal inflammatory infiltrate on mucosal biopsies. Despite such broad use of colonoscopy in the evaluation of IBS symptoms, data addressing the actual prevalence of colonic structural abnormalities in patients with IBS are limited.Īnother potential concern in patients with IBS symptoms are the microscopic colitides. Furthermore, a recent national database analysis found that roughly a quarter of all colonoscopies performed in the United States are for IBS-related symptoms, and 1 in 10 colonoscopies performed in patients under the age of 50 are for IBS symptoms ( 7). For example, community-based surveys indicate that half of IBS patients undergo colonoscopy as part of the evaluation of their symptoms ( 6). Owing to this, patients with typical IBS symptoms commonly undergo colonoscopy. Physicians are particularly concerned about missing colorectal cancer (CRC) or inflammatory bowel diseases (IBDs) such as ulcerative colitis or Crohn’s disease in patients with IBS symptoms, especially those that include a diarrheal component.
Owing to concerns about mislabeling a patient with an organic disease with IBS, health-care providers often order a battery of tests in patients with suspected IBS. The lack of reliable biomarkers and overlap of IBS symptoms with other organic conditions cause most health-care providers to consider IBS a “ diagnosis of exclusion” ( 5).
IBS patients are typically subgrouped on the basis of differences in predominant bowel pattern as diarrhea-predominant (IBS-D), constipation-predominant (IBS-C), or a mixture of both diarrhea and constipation-related features (IBS-M). IBS is heterogeneous both in terms of pathophysiology and symptom expression. Population-based studies from the United States report that the prevalence of IBS is 7–15% and that this condition occurs more commonly in women than men ( 2– 4). The irritable bowel syndrome (IBS) is a symptom-based condition in which affected individuals report recurrent bouts of abdominal pain or discomfort associated with altered bowel habits ( 1).
0 kommentar(er)
