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Background Irritable bowel syndrome (IBS) is a gastrointestinal disorder characterized by chronic abdominal pain and altered bowel habits in the absence of any organic cause. Irritable bowel syndrome is considered a functional illiness wih no diagnostic biomarkers or pathologic findings. The most common diagnosis made in patients with chronic diarrhea is IBS. MC is a clinical syndrome of unknown etiology, characterized by chonic watery diarrhea in the absence of macroscopic changes in the large bowel, but with histological examination changes Objective The aim of this study is to determine the frequency of microscopic colitis in patients with IBS of diarrhea predominant sub type. Methods This prospective study had been conducted on 100 subjects, age range 19-65 year from National Hepatology and Tropical medicine reaserch Institute and Ain Shams University hospital inpatient and outpatient clinics. The study was carried on over 2 years (2016-2018) duration. The study subjects were fulfilling Rome criteria. The main complain of the selected patients was abdominal pain associated with chronic watery diarrhea. Results This study showed that patients with microscopic colitis can be misdiagnosed as IBS – diarrhea predominant due similar presentation and normal macroscopic picture in endoscopy. In this study we found that 14 (14%) had microscopic colitis. This study showed that there is a significant difference between patients with normal biopsy and others with microscopic colitis as regard age and sex. Conclusions Our study showed that MC is not uncommon in Upper Egypt patients with chronic watery diarrhea and normal colonoscopic findings. Biopsy of the normal colonic mucosa in patient with chronic watery diarrhea is emphasized to reach a definite diagnosis of MC. Abdominal pain, nocturnal diarrhea and weight loss were the most common clinical manifestations of MC. MC types, LC, and CC have almost similar clinical presentations and there is no diagnostic laboratory marker; thus, histopathologic diagnosis is the only reliable method for differentiation between these subtypes. Nocturnal diarrhea and slight weight loss can be helpful in distinguishing microscopic colitis from diarrhea predominant IBS. Collaboration between treating physicians, endoscopists and pathologists is crucial for diagnosing MC.

Frequency of Microscopic Colitis in Patients with Diarrhea predominant Irritable bowel syndrome in Egyptian Patients