Microscopic colitis – what impact do delays in diagnosis have?
Microscopic colitis is often overlooked by the public and by healthcare professionals alike. Guts UK funded Dr Sunny Raju to review how the condition is diagnosed and managed in hospitals. We speak to Sunny about what he learnt, and how everyone can get the support and treatment they need.
“Whilst regarded as a ‘benign’ condition – as it is not known to increase the risk of bowel cancer – this understates the significant impact microscopic colitis can have on an individual’s day-to-day life,” says Dr Sunny Raju from Sheffield Teaching Hospitals. “This is particularly disappointing when there is a well-recognised diagnostic method and effective treatment available.”
Microscopic colitis affects about 1 in 2,000 people in the UK, but that figure is likely to be an underestimate. The condition is often misdiagnosed as something else, either irritable bowel syndrome or diverticular disease.
To better understand how microscopic colitis is diagnosed and managed, Dr Sunny Raju carried out a review of cases in two South Yorkshire hospitals, with funding from Guts UK. Sunny looked at all cases of people referred for colonoscopies for chronic diarrhoea between 2007 and 2017, as well as people with confirmed microscopic colitis.
Missed opportunities for diagnosis
Microscopic colitis is diagnosed by taking a small tissue sample (biopsy) of the lining of the bowel during a colonoscopy. Guidelines written by the British Society of Gastroenterology (BSG) say that biopsies should be taken from the colon on both the left and right side of the body, not the rectum.
But in his Guts UK-funded study, Dr Sunny Raju found that these recommendations were not being followed in more than three-quarters of cases he studied. This means that microscopic colitis could be missed, losing an opportunity for appropriate treatment.
“In particular, if biopsies are only taken from the rectum, around 1 in 10 patients may not be diagnosed. So it’s important to take the biopsies (following the guidelines),” Sunny explains. “If a patient is going to have a colonoscopy, whilst there are many reasons to do the procedure and other things to check too, it seems a shame to not take the biopsies, given the opportunity.”
Hidden severity
Dr Raju also found in his study that hospitalisation for microscopic colitis is more common than thought.
In his study in South Yorkshire, 6% of patients with microscopic colitis were admitted to hospital because of their symptoms, including severe diarrhoea, acute kidney injury, abdominal pain, and collapse. Their hospital stays may have been preventable or reduced if they had been diagnosed effectively and treated earlier.
“Patients will tell me how severe their symptoms can be, and so it shouldn’t be surprising that some of them will struggle to manage this at home,” Sunny says. “In our study almost 1 in 5 [of people admitted] were admitted due to the severity of their diarrhoea causing complications of dehydration.”
For Sunny, it underlines how a lot of suffering is hidden behind the label of ‘benign condition’. “Whilst it may not cause cancer, this is only part of the story.”
Improving treatment
The good news is that there are a range of treatments available for microscopic colitis. The first treatment for many people is an anti-inflammatory steroid drug called budesonide. “Budesonide is an effective treatment in the majority of patients, but 1 in 5 people will still have symptoms with this medication,” Sunny says.
“There are also a number of patients who respond well to treatment but relapse when it is stopped,” he adds, “so for those who either don’t respond or have an ongoing need for treatment, more research is needed to offer better options for them.”
Focussing on microscopic colitis
Microscopic colitis is a disease that is often overlooked, but there is reason for people to be hopeful. “Microscopic colitis is treatable, but only if diagnosed,” Sunny says. “Treatment can change a person’s life, so it is crucial to take the appropriate biopsies during a colonoscopy in anyone with suggestive symptoms.
“Education for healthcare professionals is key, through CPD (continuing professional development) modules to reinforce the guidelines for investigating chronic diarrhoea. But the stories of patients, like those on the Guts UK website, also help to underline why following the diagnosis guidelines is so important.”
By increasing awareness of microscopic colitis – among both the public and healthcare professionals – we can help make sure thousands of people get the support and treatment they deserve.
