Nonsteroidal anti-inflammatory drug exposure and the risk of microscopic colitis

Abstract

Background Medication consumption has been suggested as a risk factor for microscopic colitis (MC), but studies of varying design have yielded inconsistent results. Our aim was to evaluate the association between medications and MC. Methods A hybrid cohort of prospectively identified patients undergoing colonoscopy with biopsies for suspicion of MC (N = 144) and patients with MC enrolled within three months of diagnosis into an MC registry (N = 59) were surveyed on medication use. Medication use was compared between patients with and without diagnosis of MC by chi-squared test and binomial logistic regression adjusted for known risk factors of MC: age and gender. Results In total, 80 patients with MC (21 new, 59 registry) were enrolled. Patients with MC were more likely to be older (p = 0.03) and female (p = 0.01) compared to those without MC. Aspirin and other non-steroidal anti-inflammatory drugs were more commonly used among patients who developed MC (p < 0.01). After controlling for age and gender, these medications remained independent predictors of MC with odds ratio for any non-steroidal anti-inflammatory drug use of 3.04 (95% CI: 1.65–5.69). No association between MC and other previously implicated medications including proton pump inhibitors and selective serotonin reuptake inhibitors was found. Conclusions In this cohort of patients with chronic diarrhea, we found use of aspirin and non-steroidal anti-inflammatory drugs, but not other implicated medications to be associated with the development of MC. Whether these drugs trigger colonic inflammation in predisposed hosts or worsen diarrhea in undiagnosed patients is unclear. However, we feel that these findings are sufficient to discuss potential non-steroidal anti-inflammatory drug cessation in patients newly diagnosed with MC.

Type 1 diabetes and microscopic colitis: A nationwide matched case–control study in Sweden

“…In a separate secondary analysis, we also assessed whether the association of T1D with MC may be influenced by consumption of four medications: proton pump inhibitors (PPI, per Anatomical Therapeutic Chemical [ATC] code “A02BC01‐07”), selective serotonin reuptake inhibitors (SSRI, per ATC code “N06AB”), statin (per ATC code “C10”), and non‐steroidal anti‐inflammatory drugs (NSAIDs, per ATC codes “B01AC06”, “B01AC30” and “M01A”). Selection of medications was based on the reported associations with MC onset 18–21 . In order to be considered as MC‐associated, only medications dispensed within 180 days before biopsy were included.…”

“…Selection of medications was based on the reported associations with MC onset. [18][19][20][21] In order to be considered as MC-associated, only medications dispensed within 180 days before biopsy were included.…”

The association between drugs and repeated treatment with budesonide in patients with microscopic colitis: a retrospective observational study

“…In studies that have found an association between MC and the use of PPIs and/or statins, the control group has mainly consisted of subjects from the general population; such associations have not been confirmed in control groups that consisted of patients with other causes of chronic diarrhea or in subjects referred for colonoscopy. 8 , 14 The rationale for PPIs and statins as a risk factor for MC are weakly based on current knowledge. First, both PPI 15 and statins 16 have shown anti-inflammatory effects on the gastrointestinal tract.…”

The colitis may be microscopic, but the diarrhea is not: update on the treatment of microscopic colitis and immune checkpoint inhibitor colitis

“…Similarly, in a separate study that utilized a combination of patients enrolled in a microscopic colitis registry and a prospective cohort of patients, only NSAIDs was linked to microscopic colitis. PPIs, H2Ras, SSRIs, statins, ACE-Is, and angiotensin receptor blockers (ARBs) were not linked to medication-induced microscopic colitis [16]. The strongest evidence for medication-induced microscopic colitis exist for only NSAIDs and Aspirin [16].…”

“…PPIs, H2Ras, SSRIs, statins, ACE-Is, and angiotensin receptor blockers (ARBs) were not linked to medication-induced microscopic colitis [16]. The strongest evidence for medication-induced microscopic colitis exist for only NSAIDs and Aspirin [16]. The precise mechanism by which NSAIDs and Aspirin cause microscopic colitis has not been fully described.…”