Course of Disease in Patients with Microscopic Colitis: A European Prospective Incident Cohort Study

Abstract

Background and Aims The disease course of microscopic colitis [MC] is considered chronic but benign. However, this assumption is based on mainly retrospective studies, reporting on incomplete follow-up of selective cohorts. Systematic, prospective and unbiased data to inform patients and healthcare professionals on the expected course of the disease and real-life response to therapy are warranted. Methods A prospective, pan-European, multi-centre, web-based registry was established. Incident cases of MC were included. Data on patient characteristics, symptoms, treatment and quality of life were systematically registered at baseline and during real-time follow-up. Four disease course phenotypes were discriminated and described. Results Among 381 cases with complete 1-year follow-up, 49% had a chronic active or relapsing disease course, 40% achieved sustained remission after treatment and 11% had a quiescent course. In general, symptoms and quality of life improved after 3 months of follow-up. A relapsing or chronic active disease course was associated with significantly more symptoms and impaired quality of life after 1 year. Conclusions A minority of MC patients follow a quiescent disease course with spontaneous clinical improvement, whereas the majority suffer a chronic active or relapsing disease course during the first year after diagnosis, with persisting symptoms accompanied by a significantly impaired quality of life.

The Epidemiology of Microscopic Colitis in Olmsted County, Minnesota: Population-Based Study From 2011 to 2019

“…A recent European prospective cohort study showed approximately half of MC patients have a relapsing disease course, particularly during the first year of diagnosis. 34 There were a few limitations to this study including the predominantly white population in Olmsted County, MN. In addition, despite county residents being socioeconomically similar to the US population, residents have a higher level of education and a higher percentage of people working in the health care industry compared with residents nationwide.…”

Efficacy and safety of biologic therapy in microscopic colitis: systematic review and meta-analysis

“…MC is an uncommon condition, and biologic therapy remains infrequently utilized in MC. For example, in a recent prospective incident cohort study that included 381 patients, none of the patients required biologic therapy within the first year of MC diagnosis [31]. Consequently, most of the included studies in our meta-analysis were small sized.…”

Microscopic colitis: Etiopathology, diagnosis, and rational management

“…In a recent study, the clinical course over time in a cohort of 318 patients with microscopic colitis and a mean age of 64 years with complete 1-year follow-up revealed that 49% had a chronic active or relapsing disease course; 40% achieved sustained remission after treatment, and 11% had a quiescent course ( Verhaegh et al, 2021 ). In general, symptoms and quality of life improved after 3 months of follow-up.…”

“…In general, symptoms and quality of life improved after 3 months of follow-up. A relapsing or chronic active disease course was associated with considerably more symptoms and an impaired quality of life after 1 year ( Verhaegh et al, 2021 ). Previously, another study evaluating the natural history of microscopic colitis with a median follow-up of 8 years revealed that 75% of patients achieved prolonged remission without therapy for more than a year ( Fernández-Bañares et al, 2016 ).…”