Speaker bios

Dr Kevin Barrett has been a General Practitioner in Rickmansworth, Hertfordshire since 2002. He has been a committee member of the Primary Care Society of Gastroenterology since 2017, and was Chair from 2018 to 2021. He was the RCGP and Crohn’s & Colitis UK Lead Clinical Champion for the 2017–2020 Inflammatory Bowel Disease Spotlight Project. He is particularly interested in supporting patients in Primary Care who are suffering from lower gastrointestinal issues.

Katie Baichoo is a community nurse, menopause wellbeing nurse, and midlife coach. In 2021, while nursing during Covid-19 and going through perimenopause, Katie was diagnosed with Microscopic Colitis. This followed two years of unmanageable symptoms that had been put down to stress, hormones and diet. After collapsing in a restaurant and being admitted to A&E with dehydration, she began to research the condition and look at the lifestyle and dietary choices that impacted her flares. Katie is now involved in raising awareness of Microscopic Colitis, sharing her story to help others feel less alone in dealing with the emotional and physical impact of a condition that can feel restrictive and misunderstood.

Catherine Winsor has worked in the healthcare charity sector for over 20 years, including senior roles at Prostate Cancer UK and Bowel Cancer UK, leading teams focused on improving healthcare pathways and the provision of patient support services. Catherine is passionate about health inequality and improving access to support for everyone. 

Q&A

We had many more questions than we had time to answer in the Q&A session.

Dr Kevin Barrett has shared his view on some of the questions we didn't get to, below.

Calprotectin

Question: Does a very high calprotectin level (examples given were 650 and >2,000) rule out Microscopic Colitis? Can it be that high with this condition alone? 

Kevin's answer: "There are several causes of having a raised calprotectin level, but Microscopic Colitis itself is not directly related to a rise in calprotectin. There are some things, for example the regular use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) such as ibuprofen or diclofenac, that can be associated with both a rise in calprotectin and having Microscopic Colitis. A direct link to the cause of Microscopic Colitis hasn't been established, so there could be an indirect link. However, these rises in faecal calprotectin tend to be modest and much lower than the figures mentioned. It's possible that there is more than one thing going on, or that the biopsies taken might suggest one diagnosis, but the overall pattern of symptoms and how the bowel is affected might really point to another diagnosis. The diagnosis of IBD should not rely on the biopsy findings alone, as it's also important to take other factors into account." 

Microscopic Colitis: curable? 

Question: I was diagnosed with Microscopic Colitis 7 years ago. After a recent colonoscopy biopsy shows no signs of Microscopic Colitis, can I assume I'm cured? Can it ever go away?

Kevin's answer: "Microscopic Colitis is a relapsing and remitting condition for most of those affected. However, some people have a single episode and then are never affected again. But some people have symptoms that can persist for months or even years. There is not a cure, but sometimes the symptoms and biopsies can fully settle for a long time. Unfortunately, we do not yet know why this happens or how to make it happen." 

Nausea

Question: Do other people get nausea when they need to have a bowel movement?

Kevin's answer: "Feeling sick, or nausea, seems to be a common symptom and can have a number of potential causes. The entire gastrointestinal tract is stimulated when one needs a bowel movement, so this may account for some of this; the vagus nerve plays a key part in triggering nausea too. Electrolyte disturbances can be a cause for some people, too. If the nausea is stopping you from enjoying life or sleeping, or is causing you to restrict your diet, then please speak to a healthcare professional."

EPI (Exocrine Pancreatic Insufficiency)

Questions: The questions were around whether it's common to have both EPI and Microscopic Colitis

Kevin's answer: "Yes, one can have both, although as both conditions are uncommon, this would be rare. This sounds like a double blow - I'm sorry to hear this. If the large bowel is not able to absorb water and there is also small bowel malabsorption, then this will definitely make things worse, even if both are relatively mild."

Changes to diagnosis

Question: Are there cases of Lymphocytic Colitis changing into Collagenous Colitis?

Kevin's answer: "I'm not aware of cases where Lymphocytic Colitis changes to Collagenous Colitis, or vice versa. But there are cases where people can develop a second type of Inflammatory Bowel Disease. These are rare, but as with all symptoms, if things start to feel different to your normal pattern for any reason, then it's worth going back and telling your healthcare professional." 

Collagen

Question: Is Collagenous Colitis anything to do with eating too much collagen, like bone broth? Can you take collagen supplements, or is this to be avoided? 

Kevin's answer: "There is not a link between the dietary intake of collagen and the development of Collagenous Colitis. The collagen in the bowel wall is produced by the body and is not directly formed by collagen from the diet, so collagen supplements are safe to take."