Diarrhoea is not the only symptom that needs to be treated in patients with microscopic colitis

Roth, Bodil; Bengtsson, Mariette; Ohlsson, Bodil

doi:10.1016/j.ejim.2013.02.006

Cited by 19 publications

(27 citation statements)

References 39 publications

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“…Nevertheless, in light of the current knowledge on MC, a colonic, epithelial dysfunction seems more pertinent in the pathophysiology of MC than autoimmunity 31. Intestinal ischemia, drugs, and environmental factors, such as smoking, may trigger mucosal changes which could represent an intestinal reaction to diverse irritants rather than being a specific entity 12,32…”

Section: Discussionmentioning

confidence: 99%

Microscopic Colitis and Reproductive Factors Related to Exposure to Estrogens and Progesterone

Roth

Manjer

Ohlsson

2013

Drug Target�Insights

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Microscopic colitis (MC) often debuts around or after menopause and is divided into lymphocytic- and collagenous colitis. The aim of this study was to examine whether factors influencing sex hormone levels differed between subgroups of MC as well as between patients and controls. A self-administered questionnaire about parity was completed which included questions surrounding age at first childbirth, menarche and menopause, the use of oral contraceptives, and hormonal replacement therapy. Patients with lymphocytic colitis had children less often compared to those with collagenous colitis (OR = 0.20, 95% CI = 0.05–0.86), however no differences were observed between patients with persistent or transient disease. Patients were less often older than 15 years of age at menarche (OR = 0.48, 95% CI = 0.26–0.91) and were younger at menopause (OR = 0.30, 95% CI = 0.16–0.56) compared with controls. Thus, no obvious association between factors influencing sex hormone levels and presence of MC could be found.

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Section: Discussionmentioning

confidence: 99%

Microscopic Colitis and Reproductive Factors Related to Exposure to Estrogens and Progesterone

Roth

Manjer

Ohlsson

2013

Drug Target�Insights

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“…Smoking was associated with patients fulfilling both the criteria for IBS-like symptoms and MC, and not with pure MC [Roth et al 2013a[Roth et al , 2014. It remains to be determined whether smoking causes IBS, with the ensuing need of a colonoscopy whereby microscopic inflammation can occasionally be found, or whether smoking induces true MC.…”

Section: Discussionmentioning

confidence: 99%

“…When scrutinizing all medical records in several districts of Sweden, it was found that the majority of patients had had only a single attack of MC [Olesen et al 2004a;Roth et al 2013a;Thörn et al 2013]. The same rule as for IBD should be introduced with respect to MC.…”

Section: Discussionmentioning

confidence: 99%

“…Accordingly, lung cancer is associated with MC [Chan et al 1999]. Current MC and MC in combination with abdominal pain were associated with smoking, whereas transient MC was associated with past smoking, and pure MC without abdominal pain was not associated with smoking [Roth et al 2013a[Roth et al , 2014.…”

Section: Smoking and Alcohol Habitsmentioning

confidence: 99%

“…The onset is often insidious, but 25-40% of the patients have a sudden onset [Bohr et al 1996;Olesen et al 2004a]. The majority of patients have only a single attack of the disease with spontaneous remission in about 10% [Gubbins et al 1991;Olesen et al 2004a;Roth et al 2013a;Thörn et al 2013], and the patients are in symptomatic remission after 3-4 years [Bonner et al 2000]. Thirty percent of patients with MC have a chronic intermittent disease, and only 7% have a chronic, continuous course which may be refractory to treatment [Järnerot et al 1995;Olesen et al 2004a].…”

Section: Clinical Presentationmentioning

confidence: 99%

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New insights and challenges in microscopic colitis

Ohlsson

2014

Therap Adv Gastroenterol

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Microscopic colitis (MC) is described as an inflammatory bowel disease characterized by chronic, bloodless diarrhea with normal or close to normal endoscopic findings. Histopathological examination reveals two subtypes: collagenous colitis (CC) and lymphocytic colitis (LC), which are indistinguishable clinically. The disease debuts typically in middle-aged patients, but can occur at all ages, including children. A female predominance is found in both CC and LC, but is not confirmed by others in LC. The etiology is unclear, but the disease has been assumed to be of autoimmune origin. However, several etiologies may render a microscopic inflammation in the mucosa; this is a common, universal reaction to a variety of irritants in contact with the intestinal lumen. Furthermore, some patients with a microscopic inflammation in their colonic mucosa have no symptoms, or are suffering from constipation or abdominal pain, rather than diarrhea. Recently, a discussion was initiated calling into question the overdiagnosing of symptoms and pointing out the danger of exacerbating people's perception of their ailments, of weakening their eligibility in health insurance, of overprescription of drugs, and thus the increasing cost to the society of health care. In the light of this discussion, this review will highlight histopathological and clinical features of MC, and discuss the diagnosis and management of this disease. Perhaps, the intestinal mucosa has no other mode by which to react than an inflammatory response, irrespective of the presence or absence of autoimmunity. Thus, to better identify and classify subgroups of MC, and to clarify and correctly handle the inflammatory changes, this field of research stands to benefit from a review of the results and experience gained to date.

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Drug Exposure and the Risk of Microscopic Colitis: A Critical Update

Lucendo

2017

Drugs R D

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A variety of luminal antigens, including a wide range of drugs, have been associated with the still little-known pathophysiology of microscopic colitis (MC), with variable evidence suggesting causality. This article aims to review the aspects related to drugs as potential triggers of MC; to discuss the most commonly identified associations between drugs and MC; and to analyze the limitations of the studies currently available. A literature search was performed in PubMed combining the search terms ‘drug exposure’, ‘drug consumption’, and ‘risk factors’ with ‘microscopic colitis’, ‘lymphocytic colitis’, and ‘collagenous colitis’, with no language restrictions. Reference lists of retrieved documents were also reviewed. A handful of case–control studies have demonstrated significant associations between some commonly used drugs and a higher risk of developing MC. No universally accepted criteria for establishing cause–effect relationships in adverse reactions to drugs are available, but several methods that can be applied to MC, can provide degrees of the likelihood of an association. A high probability imputation in the development of MC as a drug adverse effect has only been demonstrated for individual cases by applying chronological (challenge, de-challenge, and relapse with re-challenge) and semiological criteria. Several case–control studies have shown significant associations between exposure to drugs and MC, but the variability in their design, the reference populations used, and the definitions for drug exposure considered require specific analyses. It can be concluded that drug exposure and MC as a likely cause–effect relationship has only been described for a handful of drugs and in individual cases.

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Diarrhoea is not the only symptom that needs to be treated in patients with microscopic colitis

Cited by 19 publications

References 39 publications

Microscopic Colitis and Reproductive Factors Related to Exposure to Estrogens and Progesterone

Microscopic Colitis and Reproductive Factors Related to Exposure to Estrogens and Progesterone

New insights and challenges in microscopic colitis

Drug Exposure and the Risk of Microscopic Colitis: A Critical Update

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