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Predominant Antibody Deficiency and Risk of Microscopic Colitis: a Nationwide Case-Control Study in Sweden
Daniel V DiGiacomo1,2, Bjorn Roelstraete3, Lennart Hammarström4
1Clinical and Translational Epidemiology Unit, Mongan Institute, Massachusetts General Hospital, Boston, MA, USA.
Abstract:
PURPOSE : Predominant antibody deficiency (PAD) disorders, including common variable immunodeficiency (CVID), have been linked to increased risk of gastrointestinal infections and inflammatory bowel diseases. However, there are limited data on the relationship between PAD, specifically CVID, and risk of microscopic colitis (MC).
Methods:
We performed a nationwide case-control study of Swedish adults with MC diagnosed between 1997 and 2017 (n = 13,651). Data on biopsy-verified MC were retrieved from all of Sweden's pathology departments through the Epidemiology Strengthened by histoPathology Reports in Sweden (ESPRESSO) study. We defined predominant antibody deficiency using International Union of Immunologic Societies (IUIS) phenotypic classification. Individuals with MC were matched to population controls by age, sex, calendar year, and county. We used logistic regression to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs).
Results:
The prevalence of PAD in MC was 0.4% as compared to 0.05% in controls. After adjustment for potential confounders, this corresponded to an aOR of 7.29 (95%CI 4.64-11.63). The magnitude of the association was higher for CVID (aOR 21.01, 95% 5.48-137.44) compared to other antibody deficiencies (aOR 6.16, 95% CI 3.79-10.14). In exploratory analyses, the association between PAD and MC was particularly strong among males (aOR 31.73, 95% CI 10.82-135.04).
Conclusion:
In this population-based study, predominant antibody deficiency was associated with increased risk of MC, particularly among males. Clinicians who encounter these patients should consider a detailed infectious history and screening for antibody deficiency.
Insights
Predominant antibody deficiency (PAD) significantly increases microscopic colitis (MC) risk, especially in males. Screening for PAD is recommended for MC patients.
Area of Science:
- Immunology
- Gastroenterology
- Epidemiology
Background:
- Predominant antibody deficiency (PAD) disorders are linked to gastrointestinal issues.
- Limited data exist on the association between PAD, particularly common variable immunodeficiency (CVID), and microscopic colitis (MC).
Purpose of the Study:
- To investigate the relationship between PAD and the risk of developing MC.
- To determine if CVID specifically is associated with an increased risk of MC.
Main Methods:
- Nationwide case-control study in Sweden (1997-2017) including 13,651 MC patients.
- Biopsy-verified MC data from the ESPRESSO study; PAD defined by IUIS criteria.
- Logistic regression used to calculate adjusted odds ratios (aORs) comparing MC patients to matched population controls.
Main Results:
- Prevalence of PAD was higher in MC patients (0.4%) than controls (0.05%), yielding an aOR of 7.29.
- CVID showed a stronger association with MC (aOR 21.01) than other PADs (aOR 6.16).
- The association between PAD and MC was notably stronger in males (aOR 31.73).
Conclusions:
- Predominant antibody deficiency is associated with an increased risk of microscopic colitis.
- The risk is particularly elevated in males.
- Clinicians should consider infectious history and PAD screening in MC patients.
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