by University of Liverpool

Credit: Unsplash/CC0 Public Domain

Experts, including academics at the University of Liverpool, have raised concerns about the number of people suffering with undiagnosed microscopic colitis, a debilitating bowel condition thought to affect thousands of adults in the U.K. The national charity Guts UK has published a resource for patients during Microscopic Colitis Awareness Week to raise awareness of the disease and is calling for more research into prevention, faster diagnoses and developments in treatments.

Microscopic colitis is an inflammation of the large intestine (bowel) that causes persistent, frequent and watery diarrhea (throughout the day and night), stomach pain, fatigue, fecal incontinence and weight loss. It is frequently misdiagnosed and the prevalence of the condition is higher than previously thought.

Scientists estimate that around 67,000 people are living with microscopic colitis in the U.K. or at least 1 in 1,000 adults, and 17,000 new cases are being diagnosed each year, but the real number could be a lot higher because it's often underreported and misdiagnosed.

A 2012 study showed that one in three patients with microscopic colitis were initially incorrectly diagnosed with Irritable Bowel Syndrome (IBS) and "a large, hidden burden of undiagnosed and untreated microscopic colitis likely exists in the UK population owing to systematic misdiagnosis of microscopic colitis as IBS."

Despite the missed diagnoses, cases of microscopic colitis are on the rise globally. The U.K. incidence rate of microscopic colitis in 2016 was twice that observed in 2009.

Microscopic colitis is a leading cause of diarrhea in older adults and it can have a devastating impact on a person's quality of life. Many people suffer with the condition for years but the correct diagnosis and treatment can make a huge difference.

Microscopic colitis is named because, unlike other inflammatory bowel diseases, like Crohn's disease or ulcerative colitis, it can't be diagnosed with a colonoscopy alone and a sample of tissue taken from the bowel must be examined under a microscope to identify the condition. Because of this, the disease is often misdiagnosed.

Professor Chris Probert, Professor of Gastroenterology at the University of Liverpool said, "Undiagnosed microscopic colitis can cause years of unnecessary suffering. The diarrhea symptoms tend to be very severe and houselimiting leading to considerable distress for patients.

"It's not clear why cases of the condition are on the increase but it is likely to be due to a mixture of increased awareness of symptoms leading to more diagnoses and environmental factors such as a potential side effect of common prescription drugs such as some antidepressants.

"The good news is that effective treatments are available so people experiencing symptoms could benefit enormously by talking with their GP."

Julie Harrington, CEO of Guts UK, said, "It's terribly sad that thousands of people are suffering with the debilitating symptoms of microscopic colitis. Most people with the condition can be easily treated with a course of gut-specific steroids or with symptom-relieving medicines but getting a diagnosis is the first, essential step.

"People living with the condition but without the benefit of a correct diagnosis and effective treatments often can often feel very isolated due to the urgent nature of their symptoms and their need to be near to toilet facilities at all times. We know that this can also have a detrimental effect on their mental well-being.

"The rates of microscopic colitis are increasing and are likely to grow further as the population ages, so it's crucial that we identify risk factors, provide specific training for healthcare providers, continue to raise awareness and invest in research to improve diagnosis and treatments."

Resources published in March 2022 by Guts UK to raise awareness of microscopic colitis showed that women are 700% more likely than men to suffer with the condition.

The causes of microscopic colitis are still unclear. As it is a relatively new disease (first described in 1976) it has led to a presumption that it is environmental as opposed to genetic factors that are responsible for its occurrence.

Anyone experiencing symptoms is advised to see their GP, contact Guts UK for more information or visit gutscharity.org.uk

The resource for patients can be seen on the Guts UK website here.

More about microscopic colitis:

• Microscopic colitis (MC) is an inflammatory disease of the bowel that causes persistent, watery diarrhea, usually accompanied by urgency and problems with bowel control.

• Symptoms can be unrelenting and lead to a substantial loss of quality of life. People affected often need to identify where toilets are when they leave the house, to avoid accidents. In some cases, people are unable to leave the house at all due to the severity of their symptoms.

• Microscopic colitis can develop at any time, but it is more common in middle-age, with those affected often diagnosed between the ages of 50 and 70. It also occurs more frequently in women and can occur earlier in people who smoke.

• Microscopic colitis occurs in 18 people in 100,000 people, per year. Importantly, there are good treatments available for this condition.

• Because the only way to diagnose this condition is to take a biopsy of the large bowel, as it cannot be seen by the naked eye during an endoscopy, the disease is often misdiagnosed. The fecal calprotectin test that GPs use to rule out inflammatory bowel disease cannot be used to diagnose microscopic colitis because the inflammation levels are microscopic.

• Figures suggest 1 in 10 people with IBS with diarrhea may have microscopic colitis. Sadly, they may have suffered for many years prior to diagnosis when a good treatment was available. This is partly due to low awareness among some health professionals but also partly because of how the condition appears.

Provided by University of Liverpool