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Identification of Menopausal and Reproductive Risk Factors for Microscopic Colitis-Results From the Nurses' Health Study
Gastroenterology Unit, Massachusetts General Hospital, Boston Massachusetts, USA; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston Massachusetts, USA; Harvard Medical School, Boston Massachusetts, USA.
Gastroenterology Unit, Massachusetts General Hospital, Boston Massachusetts, USA; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston Massachusetts, USA; Harvard Medical School, Boston Massachusetts, USA.
Gastroenterology Unit, Massachusetts General Hospital, Boston Massachusetts, USA; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston Massachusetts, USA; Harvard Medical School, Boston Massachusetts, USA.
Gastroenterology Unit, Massachusetts General Hospital, Boston Massachusetts, USA; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston Massachusetts, USA; Harvard Medical School, Boston Massachusetts, USA.ORCID iD: 0000-0001-6205-3704
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2018 (English)In: Gastroenterology, ISSN 0016-5085, E-ISSN 1528-0012, Vol. 155, no 6, p. 1764-1775Article in journal (Refereed) Published
Abstract [en]

BACKGROUND & AIMS: Microscopic colitis is a chronic inflammatory disorder of the colon primarily affecting postmenopausal women. However, the relation between hormonal determinants, including reproductive and menopausal factors, and risk of microscopic colitis has yet to be characterized.

METHODS: We collected data from 227,766 women who participated in the Nurses' Health Study (NHS) and the NHSII without a baseline history of microscopic colitis. Reproductive and menopausal factors were assessed in 1988 in the NHS and 1989 in the NHSII and updated biennially. Cases of microscopic colitis were confirmed through review of pathology records. We used Cox proportional hazards modeling to estimate hazard ratios and 95% confidence intervals.

RESULTS: Through 2014 in the NHS and 2015 in the NHSII, we confirmed 275 incident cases of microscopic colitis over 5,147,282 person-years. Compared with never use, current use of menopausal hormone therapy was associated with increased risk of microscopic colitis (multivariable-adjusted hazard ratio 2.64; 95% confidence interval 1.78-3.90). The risk increased with longer duration of use (P for trend < .0001) and decreased after discontinuation (P for trend = .002). The association did not differ according to disease subtype (P for heterogeneity = .34). Similarly, ever use of oral contraceptives was associated with increased risk of microscopic colitis (multivariable-adjusted hazard ratio 1.57; 95% confidence interval 1.16-2.13). There were no associations between age at menarche, parity, age at first birth, age at menopause, or menopause type and incident microscopic colitis.

CONCLUSIONS: In 2 large prospective cohort studies, we observed an association between exogenous hormone use and incident microscopic colitis. Further studies are needed to determine the mechanisms underlying these associations.

Place, publisher, year, edition, pages
Saunders Elsevier, 2018. Vol. 155, no 6, p. 1764-1775
Keywords [en]
Parity, Age of Menopause, Collagenous Colitis, Lymphocytic Colitis
National Category
Gastroenterology and Hepatology
Identifiers
URN: urn:nbn:se:oru:diva-70773DOI: 10.1053/j.gastro.2018.08.029ISI: 000451781000030PubMedID: 30144433Scopus ID: 2-s2.0-85057540598OAI: oai:DiVA.org:oru-70773DiVA, id: diva2:1271295
Note

Funding Agencies:

National Institute of Diabetes and Digestive and Kidney Diseases at the National Institutes of Health  F32 DK115134  K23 DK099681  K24 DK098311  P30 DK043351 

Crohn's and Colitis Foundation  

National Cancer Institute at the National Institutes of Health  UM1 CA186107  UM1 CA176726 

Stuart and Suzanne Steele MGH Research Scholars Award 

Available from: 2018-12-17 Created: 2018-12-17 Last updated: 2018-12-17Bibliographically approved

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Ludvigsson, Jonas F.

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