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Published on: September 18, 2016
Pathogenesis of Microscopic Colitis: A Systematic Review
Yamile Zabana1,2, Gian Tontini3, Elisabeth Hultgren-Hörnquist4
1Gastroenterology Department, Hospital Universitari Mútua de Terrassa, Barcelona, Spain.
Background:
Whereas the exact aetiology of microscopic colitis [MC] remains unknown, a dysregulated immune response to luminal factors or medications is the most accepted pathogenesis hypothesis.
Methods:
We conducted a systematic review of the pathogenesis of MC. We applied the Joanna Briggs Institute methodologies and the PRISMA statement for the reporting of systematic reviews [PROSPERO Trial Identifier: CRD42020145008]. Populations, Exposure of interest, and Outcome [PEO] questions were used to explore the following topics in MC: 1] intestinal luminal factors; 2] autoimmunity; 3] innate immunity; 4] adaptive immunity; 5] extracellular matrix; 6] genetic risk factors; and 7] mechanism of diarrhoea. A search was done in PubMed, Embase, and Web of Science up to February 2020. A narrative description was performed explaining the findings for each aspect of MC aetiopathogenesis.
Results:
Thirty-eight documents provided evidence for PEO1, 100 for PEO2, 72 for PEO3 and 4, 38 for PEO5, 20 for PEO6, and 23 for PEO7. The majority of documents were cohorts, case reports, and case series, with a few case-control and some experimental studies. Consistency among data provided by different studies was considered to support pathogenetic hypotheses. MC is a multifactorial disease believed to involve innate and adaptive immune responses to luminal factors, genetic risk, autoimmunity, and extracellular matrix alterations, all contributing by varied mechanisms to watery diarrhoea.
Conclusions:
This is the first systematic review on the aetiology of MC supporting the notion that MC is a multifactorial disease. However, high-profile studies are lacking, and most evidence derives from small heterogeneous studies.
Insights
Microscopic colitis (MC) is a multifactorial disease involving immune responses, genetics, and autoimmunity. Further high-quality research is needed to fully understand its causes and mechanisms of diarrhea.
Area of Science:
- Gastroenterology
- Immunology
- Pathogenesis
Background:
- The exact cause of microscopic colitis (MC) is unknown.
- A dysregulated immune response to luminal factors or medications is the leading hypothesis for MC pathogenesis.
Purpose of the Study:
- To systematically review the pathogenesis of microscopic colitis (MC).
- To explore factors including intestinal luminal factors, autoimmunity, innate and adaptive immunity, extracellular matrix, genetic risk factors, and mechanisms of diarrhea in MC.
Main Methods:
- Systematic review applying Joanna Briggs Institute methodologies and PRISMA statement.
- Search of PubMed, Embase, and Web of Science databases up to February 2020.
- Narrative synthesis of findings related to MC aetiopathogenesis.
Main Results:
- Evidence was found for all explored aspects of MC pathogenesis.
- MC is considered a multifactorial disease involving immune responses, genetic predisposition, autoimmunity, and extracellular matrix alterations.
- These factors contribute to watery diarrhea through various mechanisms.
Conclusions:
- This is the first systematic review on MC etiology, supporting its multifactorial nature.
- The current evidence base for MC pathogenesis is limited by a lack of high-profile studies and the heterogeneity of existing research.
