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Microscopic Colitis and Risk of Inflammatory Bowel Disease in a Nationwide Cohort Study
Hamed Khalili1, Kristin E Burke2, Bjorn Roelstraete3
1Massachusetts General Hospital, Crohn's and Colitis Center and Harvard Medical School, Boston, Massachusetts; Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
Background & Aims:
Microscopic colitis shares pathogenetic mechanisms with inflammatory bowel disease (IBD). We studied the association between microscopic colitis and risk of incident IBD using data from a nationwide cohort study.
Methods:
We conducted a prospective cohort study of all adults who received a diagnosis of microscopic colitis from 1990 through 2017 in Sweden and risk of incident IBD. Cases of microscopic colitis (n= 13,957) were identified through Systematized Nomenclature of Medicine codes from the ESPRESSO (Epidemiology Strengthened by histoPathology Reports in Sweden) study, which included gastrointestinal pathology reports from all of Sweden's 28 centers. Individuals with microscopic colitis were matched to 5 general population controls (n = 66,820) and to unaffected siblings (n =13,943). Cox regression was used to estimate adjusted hazard ratio (aHRs) and 95% confidence intervals (CIs).
Results:
Through December of 2017, we identified 323 incident cases of ulcerative colitis (UC) and 108 incident cases of Crohn's disease (CD) in patients with microscopic colitis compared with 94 UC and 42 CD cases in population comparators. Mean times from diagnosis of microscopic colitis to diagnosis of CD was 3.3 ± 3.2 years and to diagnosis of UC was 3.2 ± 3.5 years. In multivariable models, microscopic colitis was associated with an aHR of 12.6 (95% CI 8.8-18.1) for CD, 17.3 (95% CI 13.7-21.8) for UC, and 16.8 (95% CI 13.9-20.3) for IBD. The 10-year absolute excess risks of CD and UC were 0.9 (95% CI 0.7-1.1) and 2.6 (95% CI 2.2-2.9) percentage points, respectively. In sensitivity analyses, comparing patients with microscopic colitis with their unaffected siblings, the aHRs of CD and UC were 5.4 (95% CI 3.2-9.2) and 9.4 (95% CI 6.4-13.8), respectively.
Conclusions:
In a population-based study in Sweden, we found a significant increase in risk of incident IBD among patients with microscopic colitis. Future studies should focus on potential mechanisms underlying these observed associations.
Insights
Patients with microscopic colitis have a significantly higher risk of developing inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC). This nationwide study highlights a strong association between these gastrointestinal conditions.
Area of Science:
- Gastroenterology
- Epidemiology
Background:
- Microscopic colitis shares underlying mechanisms with inflammatory bowel disease (IBD).
- Understanding the association between microscopic colitis and the risk of developing IBD is crucial for patient management and research.
Purpose of the Study:
- To investigate the association between a diagnosis of microscopic colitis and the subsequent risk of developing incident inflammatory bowel disease (IBD).
Main Methods:
- A prospective nationwide cohort study in Sweden (1990-2017) identified 13,957 individuals with microscopic colitis.
- Cases were matched with 66,820 general population controls and 13,943 unaffected siblings.
- Cox regression analysis was employed to calculate adjusted hazard ratios (aHRs) for incident IBD.
Main Results:
- Microscopic colitis was associated with a significantly increased risk of Crohn's disease (aHR 12.6) and ulcerative colitis (aHR 17.3).
- The 10-year absolute excess risks for Crohn's disease and ulcerative colitis were 0.9% and 2.6%, respectively.
- Sensitivity analyses comparing with siblings also showed elevated risks for Crohn's disease (aHR 5.4) and ulcerative colitis (aHR 9.4).
Conclusions:
- A diagnosis of microscopic colitis is linked to a substantially elevated risk of developing IBD.
- Further research is warranted to elucidate the specific pathogenetic mechanisms connecting microscopic colitis and IBD.
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