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Long-term prognosis of clinical symptoms and health-related quality of life in microscopic colitis: a case-control study
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden.ORCID iD: 0000-0002-0942-0816
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden.
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Clinical Epidemiology and Biostatistics, Örebro University Hospital, Örebro, Sweden; Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.ORCID iD: 0000-0001-6328-5494
Örebro University Hospital. Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden.ORCID iD: 0000-0003-2191-9625
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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. Vol. 39, no 9, p. 963-972
National Category
Gastroenterology and Hepatology Pharmacology and Toxicology
Identifiers
URN: urn:nbn:se:oru:diva-34938DOI: 10.1111/apt.12685ISI: 000333553000007PubMedID: 24612051Scopus ID: 2-s2.0-84898601507OAI: oai:DiVA.org:oru-34938DiVA, id: diva2:715610
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: 2018-06-07Bibliographically 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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Nyhlin, NilsWickbom, AnnaMontgomery, Scott M.Tysk, CurtBohr, Johan

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