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Stable Incidence of Collagenous Colitis and Lymphocytic Colitis in Orebro, Sweden, 1999-2008: A Continuous Epidemiologic Study
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.
Dept Pathology, Örebro Univ Hosp, Örebro, Sweden.
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Univ Örebro, Clin Epidemiol & Biostat Unit, Örebro University Hospital, Örebro, Sweden.
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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.

Place, publisher, year, edition, pages
2013. Vol. 19, no 11, p. 2387-2393
Keywords [en]
microscopic colitis, collagenous colitis, lymphocytic colitis, incidence, prevalence, celiac disease
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
URN: urn:nbn:se:oru:diva-33714DOI: 10.1097/MIB.0b013e31829ed8cdISI: 000329354500014OAI: oai:DiVA.org:oru-33714DiVA, id: diva2:695881
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: 2018-05-21Bibliographically approved
In thesis
1. Epidemiological aspects of microscopic colitis
Open this publication in new window or tab >>Epidemiological aspects of microscopic colitis
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
microscopic colitis, epidemiology, risk factors, comorbidity, health-related quality of life
National Category
General Practice Gastroenterology and Hepatology
Identifiers
urn:nbn:se:oru:diva-55801 (URN)978-91-7529-188-8 (ISBN)
Public defence
2017-05-26, Örebro universitet, Campus USÖ, hörsal C3, Södra Grev Rosengatan 32, Örebro, 09:00 (Swedish)
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Available from: 2017-02-16 Created: 2017-02-16 Last updated: 2018-01-13Bibliographically approved

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Wickbom, AnnaBohr, JohanUdumyan, RuzanNyhlin, NilsTysk, Curt

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