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Clinical Characteristics and Treatment Response in Microscopic Colitis Based on Age at Diagnosis: A Multicenter
Amrit K Kamboj1, Jessica McGoldrick2, Eli Voth3
1Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
Background:
Microscopic colitis (MC) primarily affects older adults; thus, data in younger patients are scarce.
Aims:
To compare clinical characteristics and treatment response by age at diagnosis.
Methods:
This retrospective cohort study was performed at Mayo Clinic and Massachusetts General Hospital. Patients were chosen consecutively using established databases. Patients were 'younger' if age at diagnosis was ≤ 50 years and 'older' if age > 50 years. Treatment outcomes were captured for induction (12 ± 4 weeks), based on the total number of daily stools, and defined as remission (complete resolution), response (≥ 50% improvement), non-response (< 50% improvement), and intolerance. Patients were considered 'responders' if they had remission or response and 'non-responders' if they had non-response or intolerance.
Results:
We included 295 patients (52 younger, 243 older). There were no differences in sex, race, MC subtype, and diarrhea severity between groups (all P > 0.05). Younger patients were more likely to have celiac disease (17.3% vs. 5.8%, P = 0.01), while older patients had higher BMI (mean 25.0 vs. 23.8 kg/m2, P = 0.04) were more likely smokers (53.9% vs. 34.6%, P = 0.01) and use NSAIDs (48.6% vs. 15.4%, P < 0.01) and statins (22.6% vs. 3.8%, P < 0.01). Overall treatment response was highest for budesonide (88.3%) and did not differ when comparing older to younger patients (90.6% vs. 77.8%, P = 0.12) or by MC subtype (LC, 81.5% vs. CC, 92.9%, P = 0.07).
Conclusions:
There are no significant differences in MC treatment response based on age or disease subtype. These findings support treating patients with MC based on symptom severity rather than age.
Insights
Microscopic colitis treatment response is similar in younger and older adults. These findings support individualized treatment based on symptom severity, not age.
Area of Science:
- Gastroenterology
- Internal Medicine
- Clinical Research
Background:
- Microscopic colitis (MC) predominantly affects older individuals, leading to limited data on younger patients.
- Understanding age-related differences in MC is crucial for effective patient management.
Purpose of the Study:
- To compare clinical characteristics and treatment responses in younger versus older patients diagnosed with microscopic colitis.
- To identify potential age-specific factors influencing MC presentation and outcomes.
Main Methods:
- A retrospective cohort study involving 295 patients (≤50 years: younger; >50 years: older) from Mayo Clinic and Massachusetts General Hospital.
- Clinical data, including demographics, comorbidities, and treatment outcomes (remission, response, non-response, intolerance), were analyzed.
- Patients were categorized as 'responders' (remission or response) or 'non-responders' (non-response or intolerance).
Main Results:
- No significant differences were observed in sex, race, MC subtype, or diarrhea severity between younger and older groups.
- Younger patients showed a higher incidence of celiac disease (17.3% vs. 5.8%).
- Older patients had higher BMI, were more likely to be smokers, and had increased use of NSAIDs and statins.
- Overall treatment response to budesonide was high (88.3%) and did not significantly differ between age groups (90.6% vs. 77.8%) or MC subtypes (81.5% vs. 92.9%).
Conclusions:
- Treatment response for microscopic colitis does not significantly vary based on patient age or disease subtype.
- Clinical management of MC should prioritize symptom severity over patient age.
- These findings advocate for personalized treatment strategies tailored to individual patient needs.
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