Skip to main content
The Egyptian Journal of Internal Medicine
Download PDF
  • Original article
  • Open access
  • Published:

Microscopic colitis in Egyptian population: study of some contributing factors and role of chromogranin A as a diagnostic marker

The Egyptian Journal of Internal Medicine volume 29, pages 164–169 (2017)Cite this article

Abstract

Background

Microscopic colitis (MC) and irritable bowel syndrome (IBS) have similar symptoms and a normal endoscopic appearance, as well as normal radiologic findings. Several studies have shown that MC can be mistakenly diagnosed as IBS. Over recent decades, MC has emerged as a common cause of diarrhea, especially in middle-aged or older women, and the disease is regarded as a subgroup within inflammatory bowel disease.

The prevalence of MC in Egyptian patients with chronic watery nonbloody diarrhea is high when compared with that in developed countries. MC mainly affects young and middle-aged patients, and it is more commonly of the lymphocytic type. Chromogranin A is a common marker for endocrine cells, and the present finding suggests that colonic hormones are involved in the pathophysiology of lymphocytic colitis (LC). The chromogranin cell density seems to be a good diagnostic marker with high sensitivity and specificity in both the right and left colon; thus, sigmoidoscopy can be used in the diagnosis of LC using this marker.

Aim

The aim of the current work is to study the prevalence of MC among patient presented with symptoms of IBS.

In addition, it is to determine whether chromogranin A cell density is increased in patients with MC and to examine the possibility of using it as a marker for the diagnosis of LC and collagenous colitis.

Patients and methods

The study was conducted initially on 100 patients presented with symptoms of IBS according to Rome IV criteria. Overall, 50 patients were excluded after finding an organic cause for their symptoms by diagnostic studies.

Results

A total of 37 cases were diagnosed as having nonspecific colitis, five cases were diagnosed as having MC (10% of the total cases studied), four cases were found to have ulcerative colitis, three cases was found to have eosinophilic colitis, and one case was found to have melanosis coli.

Conclusion

The initial results of our study revealed that MC is not an uncommon disease, and there was a significant correlation between using NSAID and proton pump inhibitor and smoking, with cases proved to have MC.

References

  1. Nguyen GC, Smalley WE, Vege SS, Carrasco-Labra A. the Clinical Guidelines Committee. American Gastroenterological Association Institute Guideline on the Medical Management of Microscopic Colitis. Gastroenterology 2016; 150:242–246.

    Article  Google Scholar 

  2. Madisch A, Bethke B, Stolte M, Miehlke S. Is there an association of microscopic colitis and irritable bowel syndrome – a subgroup analysis of placebo controlled trials. World J Gastroenterol 2005; 11:6409.

    Article  Google Scholar 

  3. Limsui D, Pardi DS, Camilleri M, Loftus EV Jr, Kammer PP, Tremaine WJ, Sandborn WJ. Symptomatic overlap between irritable bowel syndrome and microscopic colitis. Inflamm Bowel Dis 2007; 13:175–181.

    Article  Google Scholar 

  4. Abboud R, Pardi DS, Tremaine WJ, Kammer PP, Sandborn WJ, Loftus EV Jr. Symptomatic overlap between microscopic colitis and irritable bowel syndrome: a prospective study. Inflamm Bowel Dis 2013; 19:550–553.

    Article  Google Scholar 

  5. El-Salhy M, Gundersen D, Hatlebakk JG, Hausken T. Chromogranin A cell density as a diagnostic marker for lymphocytic colitis. Dig Dis Sci 2012; 57:3154–3159.

    Article  CAS  Google Scholar 

  6. Lacy BE, Mearin F, Chang L, Chey WD, Lembo AJ, Simren M, Spiller R. Bowel disorders. Gastroenterology 2016; 150:1393–1407.

    Article  Google Scholar 

  7. Pardi DS, Smyrk TC, Tremaine WJ, Sandborn WJ. Microscopic colitis: a review. Am J Gastroenterol 2002; 97:794–802.

    Article  Google Scholar 

  8. Stoicescu A, Becheanu G, Dumbrava M, Gheorghe C, Diculescu M. Microscopic colitis – a missed diagnosis in diarrhea-predominant irritable bowel syndrome. Maedica (Buchar) 2012; 7:3–9.

    Google Scholar 

  9. Münch A, Aust D, Bohr J, Bonderup O, Fernández Bañares F, Hjortswang H, et al. for the European Microscopic Colitis Group. (EMCG) Microscopic colitis: current status, present and future challenges. J Crohn’s Colitis 2012; 6:932–945.

    Article  Google Scholar 

  10. Ramadan Abdelhai A, Fattah S, Ismail WA, El-Kashishy KA. The yield of mapping biopsy from apparent endoscopically normal colon and correlation with symptoms. J Gastroenterol Hepatol Res 2014; 3:1168–1172.

    Google Scholar 

  11. Gado AS, Ebeid BA, El Hindawi AAz, Akl MM, Anthony T. Axon prevalence of microscopic colitis in patients with chronic diarrhea in egypt: a single-center study. Saudi J Gastroenterol 2011; 17:383–386.

    Article  Google Scholar 

  12. Valle Mansilla JL, León Barúa R, Recavarren Arce S, Berendson Seminario R, Biber Poillevard M. Microscopic colitis in patients with chronic diarrhea. Rev Gastroenterol Peru 2002; 22:275–278.

    CAS  PubMed  Google Scholar 

  13. Essid M, Kallel S, Ben Brahim E, Chatti S, Azzouz MM. Prevalence of the microscopic colitis to the course of the chronic diarrhea: about 150 cases. Tunis Med 2005; 83:284–287.

    PubMed  Google Scholar 

  14. Ozdil K, Sahin A, Calhan T, Kahraman R, Nigdelioglu A, Akyuz U, Sokmen HM. The frequency of microscopic and focal active colitis in patients with irritable bowel syndrome. BMC Gastroenterol 2011; 11:96.

    Article  Google Scholar 

  15. Magro F, Langner C, Driessen A, Ensari A, Geboes K, Mantzaris GJ, et al. European consensus on the histopathology of inflammatory bowel disease. J Crohns Colitis 2013; 7:827–851.

    Article  CAS  Google Scholar 

  16. Chey WD, Nojkov B, Rubenstein JH, Dobhan RR, Greenson JK, Cash BD. The yield of colonoscopy in patients with non-constipated irritable bowel syndrome: results from a prospective, controlled US trial. Am J Gastroenterol 2010; 105:859–865.

    Article  Google Scholar 

  17. Olesen M, Eriksson S, Bohr J, Järnerot G, Tysk C. Microscopic colitis: a common diarrhoeal disease. An epidemiological study in Orebro, Sweden, 1993–1998. Gut 2004; 53:346–350.

  18. Pardi DS, Loftus EVJr, Smyrk TC, Kammer PP, Tremaine WJ, Schleck CD, et al. The epidemiology of microscopic colitis: a population based study in Olmsted County, Minnesota. Gut. 2007; 56:504–508.

    Article  Google Scholar 

  19. Tavakkoli H, Esmaeili FS, Emami MH, Mahzouni P, Haghdani S. Is microscopic colitis a missed diagnosis in diarrhea-predominant irritable bowel syndrome? JRMS 2008; 13:202–206.

    Google Scholar 

  20. Calabrese C, Gionchetti P, Liguori G, Areni A, Fornarini GS, Campieri M, Rizzello F. Clinical course of microscopic colitis in a single center cohort study. J Crohns Colitis 2011; 5:218–221.

    Article  Google Scholar 

  21. Misra V, Misra SP, Dwivedi M, Singh PA, Agarwal V. Microscopic colitis in patients presenting with chronic diarrhea. Indian J Pathol Microbiol 2010; 53:15–19.

    Article  Google Scholar 

  22. El-Matary W, Girgis S, Huynh H, Turner J, Diederichs B. Microscopic colitis in children. Dig Dis Sci 2010; 55:1996–2001.

    Article  Google Scholar 

  23. Singh P, Das P, Jain AK, Mathan M, Mathur M, Bhat AS, et al. Microscopic colitis in children with chronic diarrhea. J Pediatr Gastroenterol Nutr 2013; 57:240–244.

    Article  Google Scholar 

  24. Beaugerie L, Pardi DS. Review article: drug-induced microscopic colitis – proposal for a scoring system and review of the literature. Aliment Pharmacol Ther 2005; 22:277–284.

    Article  CAS  Google Scholar 

  25. Keszthelyi D, Jansen SV, Schouten GA, de Kort S, Scholtes B, Engels LG, Masclee AA. Proton pump inhibitor use is associated with an increased risk for microscopic colitis: a case-control study. Aliment Pharmacol Ther 2010; 32:1124–1128.

    Article  CAS  Google Scholar 

  26. Khan WI, Ghia JE. Gut hormones: emerging role in immune activation and inflammation. Clin Exp Immunol 2010; 161:19–27.

    CAS  PubMed  PubMed Central  Google Scholar 

  27. Yen EF, Pardi DS. Review article: microscopic colitis-lymphocytic, collagenous and ‘mast cell’ colitis. Aliment Pharmacol Ther 2011; 34:21–32.

    Article  CAS  Google Scholar 

  28. Vigren L, Sjöberg K, Benoni C, Tysk C, Bohr J, Kilander A, et al. Is smoking a risk factor for collagenous colitis? Scand J Gastroenterol 2011; 46:1334–1339.

    Article  Google Scholar 

  29. Roth B, Gustafsson RJ, Jeppsson B, Manjer J, Ohlsson B. Smoking and alcohol habits in relation to the clinical picture of women with microscopic colitis compared to controls. BMC Womens Health 2014; 14:16.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine and Gastroenterology, Faculty of Medicine, October 6 University, Cairo, Egypt

    Mohamed S. Gomaa (MD, Associate Professor of Medicine)

  2. Department of Internal Medicine and Gastroenterology, Faculty of Medicine, Ain Shams University, Cairo, Egypt

    Ahmad S. Elsawaby, Emad A. Awad & Magdy G. Abdel Rahman

Authors
  1. Mohamed S. Gomaa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ahmad S. Elsawaby
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Emad A. Awad
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Magdy G. Abdel Rahman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mohamed S. Gomaa.

Additional information

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gomaa, M.S., Elsawaby, A.S., Awad, E.A. et al. Microscopic colitis in Egyptian population: study of some contributing factors and role of chromogranin A as a diagnostic marker. Egypt J Intern Med 29, 164–169 (2017). https://doi.org/10.4103/ejim.ejim_36_17

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/ejim.ejim_36_17

Keywords