Autoimmune diseases in microscopic colitis: A Danish nationwide case–control study

Abstract

Background:The association between autoimmune diseases and microscopic colitis remains uncertain. Aims:To describe the association between autoimmune diseases and microscopic colitis by using a matched case-control design based on nationwide registry data. Methods:All adult Danish patients with a diagnosis of microscopic colitis from 2001 to 2018 were identified from nationwide registries. Odds of autoimmune diseases were compared between cases with microscopic colitis and sex-and age-matched controls from the background population in a 1:10 ratio and evaluated by logistic regression calculating odds ratios (OR) with 95% confidence intervals (CI) adjusted for comorbidity. Analyses were stratified according to sex, age and the subtypes of lymphocytic and collagenous colitis. Results:We identified 15 597 cases with microscopic colitis and matched to 155 910 controls. In total, 3491 (22%) of patients with microscopic colitis had concomitant autoimmune disease compared to 16 521 (11%) of controls (OR, 2.46; 95% CI, 2.36-2.56). Adjusting for comorbidities reduced the OR to 2.09 (95% CI, 2.01-2.19).Analyses showed increased ORs with 16 different autoimmune diseases, particularly of gastrointestinal and endocrine origin, and connective tissue disorders. The highest ORs were for coeliac disease (OR = 10.15; 95% CI, 8.20-12.6), Crohn's disease (OR = 2.47; 95% CI, 2.10-2.91) and ulcerative colitis (OR = 6.73; 95% CI, 6.20-7.30). In stratified analyses younger age at diagnosis and collagenous colitis were associated with higher odds. Conclusion:Using nationwide registry data, microscopic colitis was associated with a wide range of autoimmune diseases, especially of gastrointestinal origin. The results suggest an autoimmune predisposition to microscopic colitis.

Editorial: autoimmune diseases in microscopic colitis—how does this information help clinicians?

“…2 Wildt and colleagues recently presented the results of a large case-control study showing increased odds of several autoimmune diseases in patients with microscopic colitis compared to matched controls. 3 This association has been reported previously. [4][5][6] However, this study included all adults in the Danish population-based registry matched to 10 controls from the general population, allowing for an estimate of the magnitude of the association with several individual autoimmune diseases.…”

The association between microscopic colitis and celiac disease: a systematic review and meta-analysis

“…A further 31 articles were excluded, because 17 did not include the necessary data, 8 were case series and 6 had no full text available for review. This left 6 cross-sectional studies, 15 cohort studies and 5 case-control studies to be included in the analysis [ 11 , 13 - 16 , 40 - 60 ].…”

“…The median age of onset is approximately 65 years for CC and 62 years for LC [ 9 - 11 ]. The exact pathogenesis and development of MC are still poorly understood, but multiple studies have suggested an association between MC and multiple different autoimmune diseases within the gastrointestinal (GI) tract, as well as in other organ systems, with the suggestion that these conditions share a similar underlying pathophysiology [ 12 , 13 ]. Type 1 diabetes mellitus and autoimmune thyroiditis are autoimmune diseases that are commonly concurrent with MC outside the GI tract [ 1 , 14 ].…”

Insights into the underlying mechanisms and clinical management of microscopic colitis in relation to other gastrointestinal disorders

“…However, the overwhelming majority of these reports are case reports or case series, with three of them reporting the transformations of CC to UC [ 44–46 ], four reporting the transformations of CC to CD [ 47–50 ], and one reporting the transformation of LC to UC [ 49 ]. Apart from these scattered cases, only a single recent cohort study [ 4 ] and a recent case–control study [ 51 ] have examined this conversion relationship. The cohort study was conducted as a nationwide prospective study in which researchers included 13,957 patients with MC and found a remarkable association of MC with IBD, with an adjusted hazard ratio of 12.6 (95% CI, 8.8–18.1) for CD, 17.3 (95% CI, 13.7–21.8) for UC, and 16.8 (95% CI, 13.9–20.3) for IBD, and when comparing patients with MC with their non-affected siblings, they were still at significant risk of developing IBD.…”

“…Coeliac disease is the most common concomitant autoimmune disorder in patients with MC [ 74 ] and there is an equally bidirectional relationship that can be established between the two entities. The latest case–control study revealed a >10-fold risk of celiac disease in patients with MC compared with the general population (OR = 10.15; 95% CI, 8.20–12.6) [ 51 ]. The conclusion is similar to those of other population-based and epidemiological studies [ 73 , 75–78 ].…”