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International Journal of Colorectal Disease

, Volume 29, Issue 7, pp 799–803 | Cite as

Microscopic colitis: clinical characteristics, treatment and outcomes in an Irish population

  • Aoibhlinn O’Toole
  • Alan Coss
  • Grainne Holleran
  • Denise Keegan
  • Glen Doherty
  • Kieran Sheahan
  • Hugh Mulcahy
  • Diarmuid O’Donoghue
Original Article

Abstract

Background and aims

Many aspects of microscopic colitis remain poorly understood. Our aim was to report a single centre experience with this condition.

Methods

Two hundred and twenty-two patients (52 male, 170 female; median age 64 years; range 32–90) diagnosed between 1993 and 2010 were studied. Medical notes were reviewed, and data on age, gender, clinical features, history of autoimmune diseases, medication use, cigarette smoking, histology and outcome were collected.

Results

There were 99 cases of lymphocytic and 123 of collagenous colitis. Diarrhoea was almost invariably present (98 %) while abdominal pain (24 %), weight loss (10 %), faecal incontinence (8 %) and blood PR (5 %) were also described. Twenty-eight percent had concomitant autoimmune diseases, most commonly coeliac disease. Patients were taking a variety of medications at diagnosis thought to be associated with microscopic colitis including NSAIDs (22 %), aspirin (19 %), statins (15 %), proton pump inhibitors (19 %) and SSRIs (10 %) at diagnosis. Prior to the widespread use of budesonide in our institution, 33 % of patients required two or more medications during therapy compared to 15 % following the introduction of budesonide (p = 0.001). Thirty-eight percent of patients achieved spontaneous remission with either no treatment or simple anti-diarrhoeals. Using a multivariate model, the only factor associated with spontaneous remission was male gender (RR 1.9; 95 % CI 1.0–3.6; p = 0.04). Two patients had refractory microscopic colitis; one required a colectomy while a more recent case has responded to anti-TNFα therapy.

Conclusion

Microscopic colitis is predominantly a benign and self-limiting disorder. The introduction of budesonide has revolutionised treatment of this lesser studied inflammatory bowel disease.

Keywords

Microscopic colitis Collagenous colitis Lymphocytic colitis Diarrhoea Budesonide Drug-induced colitis 

Notes

Acknowledgments

Aoibhlinn O’Toole was the University College Dublin 2010–2012 Inflammatory Bowel Disease Newman Scholar sponsored by Abbott. The study sponsors played no role in the study design, in the collection, analysis and interpretation of data or in the writing of the manuscript.

Disclosures

The authors have no disclosures.

Conference presentation

Poster presentation: Ecco Barcelona 2012

Poster presentation: DDW San Diego 2012

Author Contributions

Study concept and design; Diarmuid O’Donoghue

Acquisition of data; Aoibhlinn O’Toole, Alan Coss ,Grainne Holleran, Denise Keegan, Kieran Sheahan

Analysis and interpretation of data; Hugh Mulcahy

Drafting of the manuscript; Aoibhlinn O’Toole, Diarmuid O’Donoghue

Critical revision of the manuscript for important intellectual content; Diarmuid O’Donoghue, Hugh Mulcahy, Glen Doherty, Kieran Sheahan, Alan Coss, Grainne Holleran

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Aoibhlinn O’Toole
    • 1
    • 2
  • Alan Coss
    • 1
  • Grainne Holleran
    • 1
  • Denise Keegan
    • 1
  • Glen Doherty
    • 1
  • Kieran Sheahan
    • 1
  • Hugh Mulcahy
    • 1
  • Diarmuid O’Donoghue
    • 1
  1. 1.Centre for Colorectal DiseaseSt Vincent’s University Hospital/University College DublinDublin 4Ireland
  2. 2.Abbott Laboratories Newman Fellow in Inflammatory Bowel DiseaseDublinIreland

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