Clinical features and treatment outcomes in patients with symptoms of irritable bowel syndrome (IBS) with and without non-specific colitis (NSC) on histology

Abstract

BACKGROUND: Routine rectal biopsies in patients with IBS symptoms often show histological changes of NSC. The aetiology and pathogenesis of NSC are unclear, and there are no guidelines for treatment. OBJECTIVE: To determine clinical features and treatment outcomes in patients with IBS symptoms with and without NSC on rectal or colonic biopsies. METHODS: Consecutive patients attending an out-patient clinic diagnosed as having IBS using ROME II criteria were further studied. They all had a clinical assessment, and routine stools examination and culture, flexible sigmoidoscopy and barium enema or colonoscopy with biopsy. Patients who had normal rectal/ colonic histology (NHIBS) or NSC were given treatment for IBS symptoms with dietary modification, anti-spasmodics, anti-diarrhoeals, and anti-depressants, alone or in combination. Response to treatment was assessed after three months. RESULTS: 75 patients (M;- F=50:25; mean age 35.9 years) who had IBS symptoms and normal stool examination and large bowel endoscopy/ radiology were followed up. Six (one with ulcerative colitis, 5 with lymphocytic colitis) were excluded after rectal histology. Patients with NHIBS (n=29) and NSC (n=40) were well matched for age, gender and duration of symptoms. After 3 months of treatment for IBS symptoms, the response to treatment was similar in the two groups (NIBS Vs. 20, worsening 7 Vs 8). CONCLUSIONS; NSC is frequently seen in patients presenting with IBS symptoms. The clinical significance of this finding is unclear, as clinical features and short-term response to symptomatic treatment is similar to patients with BHIBS.