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An association between microscopic colitis and celiac disease
Peter H R Green1, Jun Yang, Jianfeng Cheng
1Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA. pg11@columbia.edu
Background & Aims:
Microscopic colitis has been associated with celiac disease. We aimed to determine the extent and significance of this relationship.
Methods:
A prospectively maintained database of celiac disease patients, seen between 1981 and 2006, was analyzed. Standardized morbidity ratios (SMR) were calculated using a general population study of microscopic colitis as the reference group. Statistical analysis was conducted using the Student t test, Pearson chi(2) test, or Fisher exact test.
Results:
Microscopic colitis was found in 44 of 1009 patients (4.3%); this represented a 70-fold increased risk for individuals with celiac disease to have microscopic colitis, compared with the general population (SMR, 72.39; 95% confidence interval [CI], 52.52-95.36). The celiac disease patients with microscopic colitis were older (P = .0001) and had more severe villous atrophy (P = .002) than the celiac disease patients without microscopic colitis. Microscopic colitis was diagnosed after celiac disease in 64% of the patients, simultaneously in 25%, and before celiac disease in 11% (P = .0001). Pancolitis predominated, though 16% had colitis limited to the right colon. Steroid or immunosuppressant therapies were required in 66% of the celiac disease patients with microscopic colitis and given as maintenance therapy to 50% of these patients. Follow-up biopsies revealed that the colitis persisted in 57% of the patients with celiac disease and microscopic colitis, despite improved diarrhea symptoms; the diarrhea resolved in most of the patients.
Conclusions:
Microscopic colitis is more common in patients with celiac disease than in the general population. Patients with celiac disease and microscopic colitis have more severe villous atrophy and frequently require steroids or immunosuppressant therapies to control diarrhea.
Insights
Microscopic colitis is significantly more common in celiac disease patients, indicating a 70-fold increased risk. These patients often have more severe villous atrophy and require immunosuppressants for diarrhea control.
Area of Science:
- Gastroenterology
- Immunology
- Internal Medicine
Background:
- Microscopic colitis is a gastrointestinal condition.
- Celiac disease is an autoimmune disorder affecting the small intestine.
- Previous studies suggest a potential association between microscopic colitis and celiac disease.
Purpose of the Study:
- To investigate the prevalence and significance of microscopic colitis in patients diagnosed with celiac disease.
- To quantify the risk of microscopic colitis among individuals with celiac disease compared to the general population.
Main Methods:
- Analysis of a prospectively maintained database of celiac disease patients from 1981 to 2006.
- Calculation of standardized morbidity ratios (SMR) for microscopic colitis in celiac disease patients.
- Statistical analysis using Student t test, Pearson chi(2) test, and Fisher exact test.
Main Results:
- Microscopic colitis was diagnosed in 4.3% of celiac disease patients, representing a 70-fold increased risk (SMR 72.39).
- Celiac disease patients with microscopic colitis were older and exhibited more severe villous atrophy.
- Sixty-six percent of these patients required steroid or immunosuppressant therapy, and 57% had persistent colitis despite symptom improvement.
Conclusions:
- Microscopic colitis is significantly more prevalent in celiac disease patients than in the general population.
- Celiac disease patients with microscopic colitis often present with more severe intestinal damage and require intensive medical management.
- The findings highlight the importance of considering microscopic colitis in celiac disease patients experiencing persistent gastrointestinal symptoms.
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