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Microscopic Colitis and Risk of Incident Acute Pancreatitis: A Nationwide Population-Based Matched Cohort Study
David Bergman1, Bjorn Roelstraete1, Ola Olén2,3,4
1Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Introduction:
Several gastrointestinal diseases have been linked to acute pancreatitis, but the risk of acute pancreatitis in microscopic colitis (MC) has not been studied.
Methods:
We conducted a nationwide, population-based, matched cohort study in Sweden of 12,140 patients with biopsy-verified MC (diagnosed in 2003-2017), 57,806 matched reference individuals, and 12,781 siblings without MC with a follow-up until 2021. Data on MC were obtained from all of Sweden's regional pathology registers (n = 28) through the ESPRESSO cohort. Data on acute pancreatitis were collected from the National Patient Register. Adjusted hazard ratios (aHR) and 95% confidence intervals (CI) were calculated using Cox regression.
Results:
During a mean follow-up of 9.9 years (SD = 4.3), 146 patients with MC and 437 reference individuals were diagnosed with acute pancreatitis (127.8 vs 80.1 per 100,000 person-years), corresponding to an aHR of 1.57 (95% CI = 1.30-1.90). Moreover, we found a positive association between MC and acute nongallstone-related pancreatitis (aHR 1.99 [95% CI = 1.57-2.51]), but not with acute gallstone-related pancreatitis (aHR 1.08 [95% CI = 0.78-1.49]). Comparing patients with MC with their unaffected siblings yielded an aHR of 1.28 (95% CI = 0.92-1.78). The risk of acute pancreatitis remained elevated also for patients with MC with a follow-up exceeding 10 years (aHR 1.75 [95% CI = 1.14-2.67]).
Discussion:
This nationwide study of more than 12,000 patients with MC demonstrated an increased risk of acute pancreatitis after MC. Hence, clinicians should have a low threshold for the evaluation of acute pancreatitis in patients with MC. In addition, these patients should receive advice and care aimed at reducing the risk of acute pancreatitis.
Insights
Microscopic colitis (MC) patients face an increased risk of developing acute pancreatitis. Early evaluation and preventative care are recommended for individuals diagnosed with MC to mitigate this risk.
Area of Science:
- Gastroenterology
- Epidemiology
- Clinical Medicine
Background:
- Gastrointestinal diseases are often linked to acute pancreatitis.
- The specific risk of acute pancreatitis in patients with microscopic colitis (MC) remains unstudied.
Purpose of the Study:
- To investigate the association between microscopic colitis and the risk of developing acute pancreatitis.
- To quantify the risk of acute pancreatitis in a large cohort of MC patients compared to reference individuals and siblings.
Main Methods:
- A nationwide, population-based, matched cohort study in Sweden.
- Inclusion of 12,140 biopsy-verified microscopic colitis patients and matched controls.
- Utilized Swedish national registers for diagnosis data and Cox regression for risk analysis.
Main Results:
- Patients with microscopic colitis showed a 57% increased risk of acute pancreatitis (aHR 1.57).
- A significant association was found with acute non-gallstone-related pancreatitis (aHR 1.99), but not gallstone-related pancreatitis (aHR 1.08).
- Elevated risk persisted with follow-up exceeding 10 years (aHR 1.75).
Conclusions:
- Microscopic colitis is associated with an increased risk of acute pancreatitis.
- Clinicians should maintain a low threshold for evaluating acute pancreatitis in MC patients.
- MC patients require targeted advice and care to reduce their risk of acute pancreatitis.
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