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Microscopic colitis and primary sclerosing cholangitis are bidirectionally associated: A nationwide matched cohort
David Bergman1, Anders Forss1,2, Jiangwei Sun1
1Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Background:
Microscopic colitis (MC) is an inflammatory disease of the colon. Although there is a known association between inflammatory bowel disease (IBD) and primary sclerosing cholangitis (PSC), evidence linking MC and PSC remains scarce. We aimed to investigate the bidirectional association between MC and PSC.
Methods:
Leveraging the nationwide Swedish histopathology cohort Epidemiology Strengthened by histoPathology Reports in Sweden, we conducted a matched cohort study (2002-2023, follow-up until 2024) and a case-control study (1987-2023). Patients with IBD were excluded. Adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) were estimated using Cox regression and adjusted odds ratios (aORs) using conditional logistic regression.
Results:
The cohort study included 21,340 patients with biopsy-confirmed MC and 101,707 matched reference individuals (matched by age, sex, birth year and county). Over a median follow-up of 7 years, PSC was diagnosed in 21 patients with MC and 15 reference individuals, corresponding to incidence rates of 11.9 (95% CI = 7.8-18.3) and 1.7 (95% CI = 1.0-2.8) per 100,000 person-years, yielding an aHR of 7.17 (95% CI = 3.69-13.9). The case-control study included 22,729 MC cases and 108,467 matched controls. Prior PSC was more frequent among MC cases (19/22,729; 0.08%) than controls (12/108,467; 0.01%), yielding an aOR of 7.26 (95% CI = 3.50-15.1). Our findings remained robust across multiple sensitivity analyses, including sibling-controlled analyses.
Conclusion:
This nationwide study reveals a bidirectional association between MC and PSC. Although absolute risks are low, these findings suggest that MC may have diagnostic relevance in suspected PSC cases, and vice versa. Physicians treating MC patients should be alert to signs and symptoms of PSC.
Insights
This study found a bidirectional association between microscopic colitis (MC) and primary sclerosing cholangitis (PSC). These findings suggest MC may be diagnostically relevant in PSC cases and vice versa.
Area of Science:
- Gastroenterology
- Hepatology
- Epidemiology
Background:
- Microscopic colitis (MC) is a colonic inflammatory disease with limited research on its association with primary sclerosing cholangitis (PSC).
- Existing evidence primarily links inflammatory bowel disease (IBD) with PSC, leaving the MC-PSC connection under-explored.
Purpose of the Study:
- To investigate the bidirectional association between microscopic colitis (MC) and primary sclerosing cholangitis (PSC).
Main Methods:
- A nationwide matched cohort study (2002-2023) and a case-control study (1987-2023) were conducted in Sweden.
- Patients with IBD were excluded. Cox regression and conditional logistic regression were used to estimate adjusted hazard ratios (aHRs) and adjusted odds ratios (aORs).
Main Results:
- The cohort study revealed a significantly higher incidence of PSC in MC patients (aHR=7.17).
- The case-control study showed prior PSC was more frequent in MC cases (aOR=7.26).
- Findings were consistent across sensitivity analyses, including sibling-controlled analyses.
Conclusions:
- A bidirectional association between microscopic colitis (MC) and primary sclerosing cholangitis (PSC) was identified.
- MC may hold diagnostic relevance for suspected PSC cases, and vice versa.
- Clinicians should monitor MC patients for potential PSC development.
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