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Epidemiological aspects of microscopic colitis
Örebro University, School of Medical Sciences.
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Microscopic colitis (MC) constitutes the main entities collagenous colitis (CC) and lymphocytic colitis (LC), diseases that are relatively recently described (in 1976 and 1989, respectively).

The aims of this thesis were to study the epidemiology of MC, to describe how these diseases affect patients in terms of symptom burden and health-related quality of life (HRQoL), to study potential risk factors such as familial factors, childhood circumstances, educational level, marital status, smoking and comorbidity, and to describe a cohort of patients with ulcerative colitis (UC) or Crohn’s disease (CD) and subsequent MC, and vice versa.

During 1999–2008 in Sweden, the mean annual incidence of MC was 10.2 per 105 inhabitants, compared with 5.2 per 105 inhabitants for CC, and 5.0 per 105 inhabitants for LC. The prevalence of MC on 31 December 2008 was 123 per 105 inhabitants. Women appeared to be especially affected – the female:male ratio was 3.6:1 in CC and 4.6:1 in LC.

Patients’ HRQoL is impaired both in active CC and in LC. Patients with CC in clinical remission have persisting symptoms: abdominal pain, fatigue, arthralgia and myalgia; LC patients in remission have persistent fatigue compared with controls. This illustrates that the longterm outcome is different in CC compared with LC.

Microscopic colitis is associated with a family history of MC, indicating that familial factors may play a role in the pathogenesis of this disease. We confirm earlier reports that smoking is a risk factor in MC.

In the present study population, CC was associated with rheumatic disease and previous appendicectomy. Moreover, CC and LC were associated with thyroid disease and coeliac disease and, interestingly, with a history of UC.

Most patients with UC or CD and subsequent MC, or vice versa, had UC or CD first and later developed MC. The majority had extensive UC and later onset of CC. Microscopic colitis should be considered in patients with UC or CD if there is onset of chronic watery diarrhoea without endoscopic relapse of mucosal inflammation.

Place, publisher, year, edition, pages
Örebro: Örebro University , 2017. , p. 76
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 160
Keywords [en]
microscopic colitis, epidemiology, risk factors, comorbidity, health-related quality of life
National Category
General Practice Gastroenterology and Hepatology
Identifiers
URN: urn:nbn:se:oru:diva-55801ISBN: 978-91-7529-188-8 (print)OAI: oai:DiVA.org:oru-55801DiVA, id: diva2:1074730
Public defence
2017-05-26, Örebro universitet, Campus USÖ, hörsal C3, Södra Grev Rosengatan 32, Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2017-02-16 Created: 2017-02-16 Last updated: 2018-01-13Bibliographically approved
List of papers
1. Stable Incidence of Collagenous Colitis and Lymphocytic Colitis in Orebro, Sweden, 1999-2008: A Continuous Epidemiologic Study
Open this publication in new window or tab >>Stable Incidence of Collagenous Colitis and Lymphocytic Colitis in Orebro, Sweden, 1999-2008: A Continuous Epidemiologic Study
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2013 (English)In: Inflammatory Bowel Diseases, ISSN 1078-0998, E-ISSN 1536-4844, Vol. 19, no 11, p. 2387-2393Article in journal (Refereed) Published
Abstract [en]

Background: The incidence of microscopic colitis (MC) has increased in several centers, but long-term epidemiologic data are missing. We report an epidemiologic study of collagenous colitis (CC) and lymphocytic colitis (LC) during 1999-2008, as a follow-up of our previous studies 1984-1998. Methods: Population-based study of residents of the catchment area of the hospital, with a new diagnosis of MC between 1999 and 2008. Patients were identified by diagnosis registers of the Departments of Medicine and Pathology. Medical files were reviewed, and colonic biopsies were reevaluated. Results: Collagenous colitis was diagnosed in 96 patients (75 females) and LC in 90 patients (74 females). The mean annual age-standardized incidence (per 100,000 inhabitants) was MC 10.2 (95% confidence interval: 8.7-11.7), CC 5.2 (4.2-6.3), and LC 5.0 (4.0-6.0). Age-specific incidence showed a peak in females older than 70 years. Prevalence (per 100,000 inhabitants) on December 31, 2008, was MC 123 (107.6-140.0), CC 67.7 (56.4-80.6), and LC 55.3 (45.2-67.1). A comparison of current study period with 1993-1998 showed unchanged mean incidence of MC, but a 2-fold increase in women older than 60 years with LC (standardized rate ratios 2.2, [1.2-3.7]) and increased female to male ratio (4.6:1 versus 2.1:1; P = 0.02) in LC. Conclusions: After an initial rise during 1980s and early 1990s, annual incidence of CC and LC has been stable during the last 15 years around 5/100,000 inhabitants for each disorder. The increasing incidence in older women with LC may be related to an increasing proportion of older individuals in the background population and increased colonoscopy frequency in elderly.

Keywords
microscopic colitis, collagenous colitis, lymphocytic colitis, incidence, prevalence, celiac disease
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-33714 (URN)10.1097/MIB.0b013e31829ed8cd (DOI)000329354500014 ()
Note

Funding Agencies:

Örebro County Research Committee  

Örebro University  

AstraZeneca  

Swedish Society of Gastroenterology  

International Organization for the Study of Inflammatory Bowel Diseases 

Available from: 2014-02-12 Created: 2014-02-12 Last updated: 2018-09-13Bibliographically approved
2. Long-term prognosis of clinical symptoms and health-related quality of life in microscopic colitis: a case-control study
Open this publication in new window or tab >>Long-term prognosis of clinical symptoms and health-related quality of life in microscopic colitis: a case-control study
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2014 (English)In: Alimentary Pharmacology and Therapeutics, ISSN 0269-2813, E-ISSN 1365-2036, Vol. 39, no 9, p. 963-972Article in journal (Refereed) Published
Abstract [en]

Background: Microscopic colitis, comprising collagenous colitis (CC) and lymphocytic colitis (LC), is a common cause of chronic diarrhoea. The long-term prognosis is not well described.

Aim: To study outcome of symptoms and health-related quality of life (HRQoL).

Methods: A case-control study using a postal questionnaire with three population-based controls per patient matched for age, sex and municipality. HRQoL was assessed by the Short Health Scale (SHS). Patients in clinical remission, defined as a mean of <3 stools/day, were evaluated separately (CC; n=72, LC; n=60).

Results: The study included 212 patients and 627 matched controls. Median disease duration was 5.9 (range 0.5-27) years and 6.4 (0.3-14.8) years for CC and LC respectively. Abdominal pain, fatigue, arthralgia, myalgia, faecal incontinence and nocturnal defecation were significantly more prevalent in CC patients compared with controls. These differences persisted in CC patients in clinical remission with respect to abdominal pain (36% vs. 21%), fatigue (54% vs. 34%), arthralgia (61% vs. 41%) and myalgia (53% vs. 37%). In LC patients, abdominal pain, fatigue, faecal incontinence and nocturnal defecation were more prevalent compared with controls. In LC patients in clinical remission, fatigue was more prevalent compared with controls (54% vs. 37%). These differences were statistically significant (P<0.05). All four HRQoL dimensions (symptom burden, social function, disease-related worry, general well-being) were impaired in patients with active CC and LC.

Conclusions: Although considered to be in clinical remission, patients with microscopic colitis suffer from persisting symptoms such as abdominal pain, fatigue, arthralgia or myalgia several years after diagnosis.

Place, publisher, year, edition, pages
Hoboken: Wiley-Blackwell, 2014
National Category
Gastroenterology and Hepatology Pharmacology and Toxicology
Identifiers
urn:nbn:se:oru:diva-34938 (URN)10.1111/apt.12685 (DOI)000333553000007 ()24612051 (PubMedID)2-s2.0-84898601507 (Scopus ID)
Note

Funding Agencies:

Örebro University Hospital Research Foundation (Nyckelfonden)

Swedish Society of Medicine (Bengt Ihre Foundation)

Örebro County Research Committee

Available from: 2014-05-05 Created: 2014-05-05 Last updated: 2018-07-22Bibliographically approved
3. Family history, comorbidity, smoking and other risk factors in microscopic colitis: a case-control study
Open this publication in new window or tab >>Family history, comorbidity, smoking and other risk factors in microscopic colitis: a case-control study
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2017 (English)In: European Journal of Gastroenterology and Hepathology, ISSN 0954-691X, E-ISSN 1473-5687, Vol. 29, no 5, p. 587-594Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Data on heredity, risk factors and comorbidity in microscopic colitis, encompassing collagenous colitis (CC) and lymphocytic colitis (LC), are limited.

AIM: The aim was to carry out a case-control study of family history, childhood circumstances, educational level, marital status, smoking and comorbidity in microscopic colitis.

METHODS: A postal questionnaire was sent in 2008-2009 to microscopic colitis patients resident in Sweden and three population-based controls per patient, matched for age, sex and municipality.

RESULTS: Some 212 patients and 627 controls participated in the study. There was an association with a family history of microscopic colitis in both CC [odds ratio (OR): 10.3; 95% confidence interval (CI): 2.1-50.4, P=0.004] and LC (OR not estimated, P=0.008). Current smoking was associated with CC [OR: 4.7; 95% CI: 2.4-9.2, P<0.001) and LC (OR: 3.2; 95% CI: 1.6-6.7, P=0.002). The median age at diagnosis was around 10 years earlier in ever-smokers compared with never-smokers.CC was associated with a history of ulcerative colitis (UC) (OR: 8.7, 95% CI: 2.2-33.7, P=0.002), thyroid disease (OR: 2.3; 95% CI: 1.1-4.5, P=0.02), coeliac disease (OR: 13.1; 95% CI: 2.7-62.7, P=0.001), rheumatic disease (OR 1.9; 95% CI: 1.0-3.5, P=0.042) and previous appendicectomy (OR: 2.2; 95% CI: 1.3-3.8, P=0.003), and LC with UC (OR: 6.8; 95% CI: 1.7-28.0, P=0.008), thyroid disease (OR: 2.4; 95% CI: 1.1-5.4, P=0.037) and coeliac disease (OR: 8.7; 95% CI: 2.8-26.7, P<0.001).

CONCLUSION: Association with a family history of microscopic colitis indicates that familial factors may be important. The association with a history of UC should be studied further as it may present new insights into the pathogenesis of microscopic colitis and UC.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2017
Keywords
inflammatory bowel diseases; microscopic colitis; risk factors; smoking
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:oru:diva-57572 (URN)10.1097/MEG.0000000000000832 (DOI)000398812100015 ()28350750 (PubMedID)2-s2.0-85016730155 (Scopus ID)
Funder
Swedish Society of Medicine
Note

Other funding Agencies:

Örebro University Hospital Research Foundation (Nyckelfonden)

Bengt Ihre Foundation  22100-2009  98031-2010  176271-2011

Örebro County Research Committee

Available from: 2017-05-04 Created: 2017-05-04 Last updated: 2018-07-20Bibliographically approved
4. Microscopic colitis in patients with ulcerative colitis or Crohn’s disease: a retrospective observational study and review of the literature
Open this publication in new window or tab >>Microscopic colitis in patients with ulcerative colitis or Crohn’s disease: a retrospective observational study and review of the literature
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(English)Manuscript (preprint) (Other academic)
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:oru:diva-57574 (URN)
Available from: 2017-05-04 Created: 2017-05-04 Last updated: 2017-10-18Bibliographically approved

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