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Microscopic colitis in Denmark and Sweden: incidence, putative risk factors, histological assessment and endoscopic
Sanna Davidson1,2,3, Klas Sjöberg2,3, Peter J H Engel1,4
1a Faculty of Health and Medical Sciences , University of Copenhagen , Copenhagen , Denmark.
Objective:
The significantly higher incidence rates of microscopic colitis (MC) in Denmark compared to Sweden remains unexplained.
Methods:
Consecutive patients with newly diagnosed MC in the neighbouring regions of Skåne in 2011-2015 and Zealand in 2010-2016 were prospectively identified. Data on large bowel endoscopies and biopsies rates were retrieved. Information on putative factors were obtained from registers and literature. Interobserver agreement between pathologists from both regions on 40 blinded hematoxylin and eosin (H&E)-stained colon biopsies (collagenous colitis (CC), lymphocytic colitis (LC), non-specific inflammation and normal) was evaluated using kappa statistics.
Results:
The mean annual incidence per 105 inhabitants in Skåne and Zealand 2010-2015 was 5.9 (95% CI 4.6-7.3) versus 16.4 (95% confidence intervals (95% CI) 13.6-19.2) for CC and 2.7 (95% CI 1.0-4.3) versus 11.1 (95% CI 8.8-13.4) for LC, respectively. Number of endoscopies with biopsy per 1000 and the rate of MC per endoscopy with biopsy was higher in Zealand (34-52/1000) than in Skåne (12-21/1000). The kappa value for overall agreement between pathologists was good (0.72; 95% CI 0.64-0.79). Prescription of proton pump inhibitors and selective serotonin reuptake inhibitors was higher in Skåne in the relevant age groups and prescription of non-steroidal anti-inflammatory drugs and smoking rate higher in Zealand. Alcohol consumption was higher in Denmark than in Sweden.
Conclusion:
The incidence of MC and number of cases per colonic biopsy was higher in Zealand and could not be readily explained by endoscopy or biopsy rates, differences in histological assessment or putative risk factors.
Insights
Microscopic colitis (MC) incidence is higher in Denmark than Sweden, unexplained by diagnostic rates or risk factors. Further research is needed to understand this disparity in MC prevalence.
Area of Science:
- Gastroenterology
- Epidemiology
- Pathology
Background:
- Microscopic colitis (MC) incidence varies geographically, with significantly higher rates reported in Denmark compared to neighboring Sweden.
- The reasons for this observed incidence disparity remain unclear, prompting further investigation into potential contributing factors.
Purpose of the Study:
- To investigate the unexplained higher incidence rates of microscopic colitis (MC) in Denmark (Zealand region) compared to Sweden (Skåne region).
- To compare diagnostic practices, histological assessment, and putative risk factors between the two regions.
Main Methods:
- Prospective identification of patients with newly diagnosed MC in Skåne (2011-2015) and Zealand (2010-2016).
- Data retrieval on large bowel endoscopies, biopsy rates, and relevant patient information from registers.
- Evaluation of interobserver agreement among pathologists on H&E-stained colon biopsies.
Main Results:
- Zealand exhibited significantly higher annual incidence rates for collagenous colitis (16.4 vs. 5.9 per 10^5) and lymphocytic colitis (11.1 vs. 2.7 per 10^5) compared to Skåne.
- Higher endoscopy and biopsy rates were observed in Zealand (34-52/1000) versus Skåne (12-21/1000).
- Good interobserver agreement (kappa=0.72) was found among pathologists, suggesting reliable histological assessment.
Conclusions:
- The higher incidence of microscopic colitis and cases per colonic biopsy in Zealand is not fully explained by differences in diagnostic rates or histological assessment.
- While some risk factors like NSAID use and smoking were higher in Zealand, and PPI/SSRI use higher in Skåne, these did not fully account for the incidence difference.
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