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

Liu, Yuanbin; Chen, Ming-Kai

doi:10.1093/gastro/goac011

Cited by 3 publications

(1 citation statement)

References 154 publications

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“…The pathogenesis of microscopic colitis is still poorly elucidated, but it is likely a result of dysbalanced immune response involving epithelial dysfunction ( Barmeyer et al, 2017 ), collagen metabolism, secretory diarrhea ( Escudero-Hernández et al, 2020 ), and microbiota ( Khalili et al, 2021 ; Aagaard et al, 2021 ; Figure 2 ), combined with the risk factors mentioned above in genetically predisposed individuals ( Ianiro et al, 2012 ). This complex area has previously been extensively covered by others ( Zabana et al, 2022 ; Liu and Chen, 2022 ; Miehlke et al, 2019 ), and we therefore focused on new data in the fields of microbiota, genetic susceptibility, and SARS-CoV2.…”

Section: Etiopathologymentioning

confidence: 99%

Microscopic colitis: Etiopathology, diagnosis, and rational management

Nielsen

Fernández‐Bañares

Sato

et al. 2022

eLife

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Microscopic colitis is an inflammatory bowel disease divided into two subtypes: collagenous colitis and lymphocytic colitis. With an increasing incidence of microscopic colitis exceeding those of ulcerative and Crohn’s disease among elderly people in some countries, microscopic colitis is a debilitating life experience. Therefore, physicians should be familiar with its clinical features and management strategies because the disease deserves the same attention as the classical inflammatory bowel diseases. Here, state-of-the-art knowledge of microscopic colitis is provided from a global perspective with reference to etiopathology and how to establish the diagnosis with the overall aim to create awareness and improve rational management in clinical practice. The immune system and a dysregulated immune response seem to play a key role combined with risk factors (e.g. cigarette smoking) in genetically predisposed individuals. The symptoms are characterized by recurrent or chronic nonbloody, watery diarrhea, urgency, weight loss, and a female preponderance. As biomarkers are absent, the diagnosis relies on colonoscopy with a histological assessment of biopsy specimens from all parts of the colon. Although the disease is not associated with a risk of colorectal cancer, a recent nationwide, population-based cohort study found an increased risk of lymphoma and lung cancer. Budesonide is the first-line therapy for management, whereas immunomodulatory drugs (including biologics) and drugs with antidiarrheal properties may be indicated in those failing, dependent, or intolerant to budesonide. In microscopic colitis induced by checkpoint inhibitors, a drug class used increasingly for a wide range of malignancies, a more aggressive therapeutic approach with biologics introduced early seems reasonable. However, particular attention needs to be drawn to the existence of incomplete forms of microscopic colitis with the risk of being overlooked in routine clinical settings.

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Section: Etiopathologymentioning

confidence: 99%

Microscopic colitis: Etiopathology, diagnosis, and rational management

Nielsen

Fernández‐Bañares

Sato

et al. 2022

eLife

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Colorectal cancer prevention in Central, Eastern European and South Caucasus countries: a review of policy approaches

Nonikashvili,

Kereselidze,

Toidze

et al. 2024

JHOM

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PurposeThis study aims to examine the availability and comprehensiveness of policies pertaining to colorectal cancer (CRC) in Central, Eastern European and South Caucasus countries, as it is a major public health concern in these regions and the second most common cause of cancer deaths among women.Design/methodology/approachWe performed a scoping review using the Arksey and O'Malley methodology, searching for publicly available policy documents from 18 countries. We described the prevention methods and activities in each country based on the World Health Organization guidelines for CRC screening.FindingsOur research found that most countries had at least five policies related to CRC prevention, which most commonly included primary, secondary and tertiary prevention measures. Elements such as promoting healthy lifestyle choices and implementing screening methods such as fecal occult blood tests, fecal immunochemical tests or colonoscopy were frequently mentioned in these policies. However, target age ranges varied among countries. Our analysis revealed a pressing need to increase the availability and utilization of CRC screening in these countries.Research limitations/implicationsOne of the main limitations of this study is that it is a desk review conducted using internet-based resources, which may have missed important sources or recent policy documents that are not yet available online. Despite our efforts to include all relevant policies, it is possible that we overlooked other policies that contain relevant information, such as those that cover cancer treatment methods. Additionally, our search excluded primary healthcare and universal healthcare coverage policies, which could include important information on CRC prevention and control activities. Additionally, as a scoping review approach was used, no critical assessment of the included studies or literature was conducted. Furthermore, due to the limited number of countries included, the comparability of the findings is limited. In future research, it would be beneficial to expand the study and collect new data from decision-makers and stakeholders to further investigate these hypotheses. It is also important to note that the presence of a policy document is not the end goal, as it is simply a step toward better outcomes.Practical implicationsIn summary, our research highlights the need for improved and unified efforts toward preventing and detecting CRC in Central, Eastern European and South Caucasus countries. This knowledge can be used to focus efforts on developing a standardized policy document and national screening program that can be adapted to meet the unique needs of each country. The importance of CRC screening, regardless of need, must be emphasized in order to aid in the transition from curative to preventive cancer care. Our study highlights the need for more detailed and science-based policies for CRC prevention and screening in Central, Eastern European and South Caucasus countries. While many countries have policies in place, they often lack key components and do not fully reflect current evidence-based guidelines. To improve population health outcomes, further research is needed to understand the implementation and enforcement of these policies as well as their impact on cancer incidence and survival. As the screening landscape evolves, countries may learn from each other and a better understanding of the complex policy frameworks that impact CRC screening is needed so that countries can update and tailor policy documents to their specific situations.Social implicationsIn conclusion, policymakers in Central, Eastern European and South Caucasus countries have implemented various policy approaches to prevent and control the CRC. The effectiveness of these approaches varies across countries and depends on several factors, including the availability of resources, the level of public awareness and the political will to implement effective policies. Further research is needed to determine the most effective policy approaches for CRC prevention in these regions and to ensure that the right policies are in place to reduce the incidence and impact of this disease.Originality/valueThe study aimed to identify gaps in existing research and areas for future work by mapping, categorizing and organizing existing evidence on CRC policies in Central, Eastern European and South Caucasus countries. Additional research is necessary to understand the implementation and enforcement of these policies and how they impact health outcomes such as cancer incidence and survival.Highlights CRC policy is heterogeneous in Central and Eastern Europe and the South Caucasus region.There are particularly important differences regarding the implementation of CRC screening.Cancer screening and palliative care approaches were less frequently included.Variations exist in the comprehensiveness of policy by prevention level and country.

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Exploring the association between microscopic colitis and celiac disease: A comprehensive analysis using the national in-patient data (2016–2019)

Altawili,

Albalawi,

Albalawi

et al. 2024

Saudi Journal of Gastroenterology

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Background: Several investigations suggested correlation between microscopic colitis (MC) and celiac disease (CD). This study aimed to examine this relationship using large-sized, population-based data with adequate control for confounding factors. Methods: This study employed the National Inpatient Sample (NIS) database over 4 years (2016–2019). Patients with/without MC in the presence/absence of CD were identified through ICD-10 codes. Univariate and multi-variate analyses involving odds ratios (OR) and 95% confidence intervals (CI) were performed. Results: Overall, 26,836,118 patients were analyzed. Of whom, 6,836 patients had MC (n = 179 with CD and n = 6,657 without CD). The mean hospital stay was not significantly different between both groups (5.42 ± 5.44 days vs. 4.95 ± 4.66 days, P = 0.202). The univariate analysis revealed a significant association between MC and CD (OR = 22.69, 95% [19.55, 26.33], P < 0.0001). In the multi-variate analysis, which adjusted for potential confounders including age, race, hospital region, hospital teaching status, ZIP income, smoking status, alcohol overuse, hypertension, diabetes mellitus, lipidemia-related disorders, non-steroidal anti-inflammatory drug use, and selected auto-immune diseases, the association remained significant (OR = 15.71, 95% CI [13.52, 18.25], P < 0.0001). Moreover, in patients with MC, the presence of CD emerged as a significant, independent variable of in-hospital mortality in univariate (OR = 2.87, 95% [1.14, 7.21], P = 0.025) and multi-variate (OR = 3.37, 95% CI [1.32, 8.60], P = 0.011) analyses. Conclusion: This study establishes a probable link between MC and CD, backed by both univariate and multi-variate analyses, while also identifying CD as an independent risk factor for increased mortality among MC patients. These findings need to be validated in real-world clinical studies.

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

Cited by 3 publications

References 154 publications

Microscopic colitis: Etiopathology, diagnosis, and rational management

Microscopic colitis: Etiopathology, diagnosis, and rational management

Colorectal cancer prevention in Central, Eastern European and South Caucasus countries: a review of policy approaches

Exploring the association between microscopic colitis and celiac disease: A comprehensive analysis using the national in-patient data (2016–2019)

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