Skip to main content

Advertisement

SpringerLink
Log in

Decreased Colorectal Cancer and Adenoma Risk in Patients with Microscopic Colitis

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Introduction

Microscopic colitis is currently considered to harbor no increased risk for colorectal cancer, based on a few small studies with limited long-term follow-up. Our aim was to identify patients with microscopic colitis, and to compare long-term rates of colorectal cancer or adenoma to a control group of patients without microscopic colitis.

Methods

We reviewed the records of patients diagnosed with microscopic colitis, as identified by a hospital-based pathology database from January 2000 to August 2008. Clinical factors, including history of adenoma or adenocarcinoma, and all colonoscopy findings, were recorded. Age and gender-matched patients without microscopic colitis served as the control in a 1:1 fashion.

Results

A total of 647 patients (153 male: 494 female) were identified with microscopic colitis (MC). Any history of colorectal cancer was detected in 1.92, 1.81, and 4.17% of patients with collagenous colitis (CC), lymphocytic colitis (LC), and controls, respectively (P = 0.095, P = 0.040, P = 0.015 for CC, LC, and all MC, respectively, comparing to controls). Overall, covariate-adjusted risk (odds ratio) of any history of colorectal cancer and colorectal adenoma in MC patients was 0.34 (95% confidence interval [CI] 0.16–0.73, P = 0.006) and 0.52 (95% CI 0.50–0.76, P < 0.0001), respectively. The mean duration of follow-up was 4.63 years, with 147/647 (22.7%) of patients with clinical follow-up >7 years.

Conclusions

In this case–control study involving a large retrospective cohort, microscopic colitis is negatively associated with the risk for colorectal cancer and adenoma. Further studies are required to determine a temporal relationship between microscopic colitis and the future development of colorectal neoplasia.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Lindstrom CG. Collagenous colitis with watery diarrhoea—a new entity? Pathol Eur. 1976;11:87–89.

    PubMed  CAS  Google Scholar 

  2. Lazenby AJ, Yardley JH, Giardiello FM, et al. Lymphocytic (“microscopic”) colitis: a comparative histopathologic study with particular reference to collagenous colitis. Hum Pathol. 1989;20:18–28.

    Article  PubMed  CAS  Google Scholar 

  3. Read NW, Krejs GJ, Read MG, et al. Chronic diarrhea of unknown origin. Gastroenterology. 1980;78:264–271.

    PubMed  CAS  Google Scholar 

  4. Pardi DS, Loftus EV Jr, Smyrk TC, et al. The epidemiology of microscopic colitis: a population based study in Olmsted County, Minnesota. Gut. 2007;56:504–508.

    Article  PubMed  Google Scholar 

  5. Limsui D, Pardi DS, Camilleri M, et al. Symptomatic overlap between irritable bowel syndrome and microscopic colitis. Inflamm Bowel Dis. 2007;13:175–181.

    Article  PubMed  Google Scholar 

  6. Kao KT, Pedraza BA, McClune AC, et al. Microscopic colitis: a large retrospective analysis from a health maintenance organization experience. World J Gastroenterol. 2009;15:3122–3127.

    Article  PubMed  Google Scholar 

  7. Maykel JA, Hagerman G, Mellgren AF, et al. Crohn’s colitis: the incidence of dysplasia and adenocarcinoma in surgical patients. Dis Colon Rectum. 2006;49:950–957.

    Article  PubMed  Google Scholar 

  8. von Roon AC, Reese G, Teare J, et al. The risk of cancer in patients with Crohn’s disease. Dis Colon Rectum. 2007;50:839–855.

    Article  Google Scholar 

  9. Canavan C, Abrams KR, Mayberry J. Meta-analysis: colorectal and small bowel cancer risk in patients with Crohn’s disease. Aliment Pharmacol Ther. 2006;23:1097–1104.

    Article  PubMed  CAS  Google Scholar 

  10. Eaden JA, Abrams KR, Mayberry JF. The risk of colorectal cancer in ulcerative colitis: a meta-analysis. Gut. 2001;48:526–535.

    Article  PubMed  CAS  Google Scholar 

  11. West J, Logan RF, Smith CJ, et al. Malignancy and mortality in people with coeliac disease: population based cohort study. BMJ. 2004;329:716–719.

    Article  PubMed  Google Scholar 

  12. Askling J, Linet M, Gridley G, et al. Cancer incidence in a population-based cohort of individuals hospitalized with celiac disease or dermatitis herpetiformis. Gastroenterology. 2002;123:1428–1435.

    Article  PubMed  Google Scholar 

  13. Smedby KE, Akerman M, Hildebrand H, et al. Malignant lymphomas in coeliac disease: evidence of increased risks for lymphoma types other than enteropathy-type T cell lymphoma. Gut. 2005;54:54–59.

    Article  PubMed  CAS  Google Scholar 

  14. Chan JL, Tersmette AC, Offerhaus GJ, et al. Cancer risk in collagenous colitis. Inflamm Bowel Dis. 1999;5:40–43.

    Article  PubMed  CAS  Google Scholar 

  15. Williams JJ, Kaplan GG, Makhija S, et al. Microscopic colitis-defining incidence rates and risk factors: a population-based study. Clin Gastroenterol Hepatol. 2008;6:35–40.

    Article  PubMed  Google Scholar 

  16. Rood E, Liu W, Hammel J, et al. Risk for colonic adenoma or dysplasia is not increased in patients with microscopic colitis [abstract]. Am J Gastroenterol. 2008;103:S540.

    Google Scholar 

  17. Pardi DS, Kammer PP, Loftus EV Jr, et al. Microscopic colitis is not associated with an increased risk of colorectal cancer [abstract]. Am J Gastroenterol. 2004;99:S115.

    Article  Google Scholar 

  18. Pardi DS, Ramnath VR, Loftus EV Jr, et al. Lymphocytic colitis: clinical features, treatment, and outcomes. Am J Gastroenterol. 2002;97:2829–2833.

    Article  PubMed  Google Scholar 

  19. Olesen M, Eriksson S, Bohr J, et al. Lymphocytic colitis: a retrospective clinical study of 199 Swedish patients. Gut. 2004;53:536–541.

    Article  PubMed  CAS  Google Scholar 

  20. Baert F, Schmit A, D’Haens G, et al. Budesonide in collagenous colitis: a double-blind placebo-controlled trial with histologic follow-up. Gastroenterology. 2002;122:20–25.

    Article  PubMed  CAS  Google Scholar 

  21. Bonderup OK, Hansen JB, Birket-Smith L, et al. Budesonide treatment of collagenous colitis: a randomised, double blind, placebo controlled trial with morphometric analysis. Gut. 2003;52:248–251.

    Article  PubMed  CAS  Google Scholar 

  22. Pardi DS. Microscopic colitis. Gastroenterol Hepatol. 2009;5:283–288.

    Google Scholar 

  23. Carmack SW, Lash RH, Gulizia JM, et al. Lymphocytic disorders of the gastrointestinal tract: a review for the practicing pathologist. Adv Anat Pathol. 2009;16:290–306.

    Article  PubMed  Google Scholar 

  24. Hart J. Non-neoplastic diseases of the small and large intestines. Philadelphia: Churchill Livingstone; 2006.

    Google Scholar 

  25. Freeman HJ. Lymphoproliferative and intestinal malignancies in 214 patients with biopsy-defined celiac disease. J Clin Gastroenterol. 2004;38:429–434.

    Article  PubMed  Google Scholar 

  26. Leffler DA, Dennis M, Hyett B, et al. Etiologies and predictors of diagnosis in nonresponsive celiac disease. Clin Gastroenterol Hepatol. 2007;5:445–450.

    Article  PubMed  Google Scholar 

  27. Olesen M, Eriksson S, Bohr J, et al. Microscopic colitis: a common diarrhoeal disease. An epidemiological study in Orebro, Sweden, 1993–1998. Gut. 2004;53:346–350.

    Article  PubMed  CAS  Google Scholar 

  28. Wolber R, Owen D, Freeman H. Colonic lymphocytosis in patients with celiac sprue. Hum Pathol. 1990;21:1092–1096.

    Article  PubMed  CAS  Google Scholar 

  29. Green PH, Yang J, Cheng J, et al. An association between microscopic colitis and celiac disease. Clin Gastroenterol Hepatol. 2009;7:1210–1216.

    Article  PubMed  Google Scholar 

  30. Matteoni CA, Goldblum JR, Wang N, et al. Celiac disease is highly prevalent in lymphocytic colitis. J Clin Gastroenterol. 2001;32:225–227.

    Article  PubMed  CAS  Google Scholar 

  31. Fine KD, Do K, Schulte K, et al. High prevalence of celiac sprue-like HLA-DQ genes and enteropathy in patients with the microscopic colitis syndrome. Am J Gastroenterol. 2000;95:1974–1982.

    Article  PubMed  CAS  Google Scholar 

  32. Fernandez-Banares F, Esteve M, Farre C, et al. Predisposing HLA-DQ2 and HLA-DQ8 haplotypes of coeliac disease and associated enteropathy in microscopic colitis. Eur J Gastroenterol Hepatol. 2005;17:1333–1338.

    Article  PubMed  CAS  Google Scholar 

  33. Tagkalidis PP, Gibson PR, Bhathal PS. Microscopic colitis demonstrates a T helper cell type 1 mucosal cytokine profile. J Clin Pathol. 2007;60:382–387.

    Article  PubMed  CAS  Google Scholar 

  34. Pardoll DM. Immunology. Stress, NK receptors, and immune surveillance. Science. 2001;294:534–536.

    Article  PubMed  CAS  Google Scholar 

  35. Holtmeier W, Hennemann A, May E, et al. T cell receptor delta repertoire in inflamed and noninflamed colon of patients with IBD analyzed by CDR3 spectratyping. Am J Physiol Gastrointest Liver Physiol. 2002;282:G1024–G1034.

    PubMed  CAS  Google Scholar 

  36. Groh V, Steinle A, Bauer S, et al. Recognition of stress-induced MHC molecules by intestinal epithelial gammadelta T cells. Science. 1998;279:1737–1740.

    Article  PubMed  CAS  Google Scholar 

  37. Girardi M, Oppenheim DE, Steele CR, et al. Regulation of cutaneous malignancy by gammadelta T cells. Science. 2001;294:605–609.

    Article  PubMed  CAS  Google Scholar 

  38. Miehlke S, Madisch A, Karimi D, et al. Budesonide is effective in treating lymphocytic colitis: a randomized double-blind placebo-controlled study. Gastroenterology. 2009;136:2092–2100.

    Article  PubMed  CAS  Google Scholar 

  39. Miehlke S, Heymer P, Bethke B, et al. Budesonide treatment for collagenous colitis: a randomized, double-blind, placebo-controlled, multicenter trial. Gastroenterology. 2002;123:978–984.

    Article  PubMed  CAS  Google Scholar 

  40. Bonderup OK, Hansen JB, Teglbjaerg PS, et al. Long-term budesonide treatment of collagenous colitis: a randomised, double-blind, placebo-controlled trial. Gut. 2009;58:68–72.

    Article  PubMed  CAS  Google Scholar 

  41. Grady WM, Carethers JM. Genomic and epigenetic instability in colorectal cancer pathogenesis. Gastroenterology. 2008;135:1079–1099.

    Article  PubMed  CAS  Google Scholar 

  42. Pfeifer GP, Rauch TA. DNA methylation patterns in lung carcinomas. Semin Cancer Biol. 2009;19:181–187.

    Article  PubMed  CAS  Google Scholar 

  43. Alyaqoub FS, Tao L, Kramer PM, et al. Prevention of mouse lung tumors and modulation of DNA methylation by combined treatment with budesonide and R115777 (ZarnestraMT). Carcinogenesis. 2006;27:2442–2447.

    Article  PubMed  CAS  Google Scholar 

  44. Tao L, Li Y, Wang W, et al. Effect of budesonide on the methylation and mRNA expression of the insulin-like growth factor 2 and c-myc genes in mouse lung tumors. Mol Carcinog. 2002;35:93–102.

    Article  PubMed  CAS  Google Scholar 

  45. Pereira MA, Li Y, Gunning WT, et al. Prevention of mouse lung tumors by budesonide and its modulation of biomarkers. Carcinogenesis. 2002;23:1185–1192.

    Article  PubMed  CAS  Google Scholar 

  46. Li L, Tao L, Lubet RA, et al. Modulation by budesonide of a CpG endonuclease in mouse lung tumors. Carcinogenesis. 2007;28:1499–1503.

    Article  PubMed  CAS  Google Scholar 

  47. Velayos FS, Terdiman JP, Walsh JM. Effect of 5-aminosalicylate use on colorectal cancer and dysplasia risk: a systematic review and metaanalysis of observational studies. Am J Gastroenterol. 2005;100:1345–1353.

    Article  PubMed  CAS  Google Scholar 

  48. Goff JS, Barnett JL, Pelke T, et al. Collagenous colitis: histopathology and clinical course. Am J Gastroenterol. 1997;92:57–60.

    PubMed  CAS  Google Scholar 

  49. Riddell RH, Tanaka M, Mazzoleni G. Non-steroidal anti-inflammatory drugs as a possible cause of collagenous colitis: a case-control study. Gut. 1992;33:683–686.

    Article  PubMed  CAS  Google Scholar 

  50. Sveinsson OA, Orvar KB, Birgisson S, et al. Clinical features of microscopic colitis in a nation-wide follow-up study in Iceland. Scand J Gastroenterol. 2008;43:955–960.

    Article  PubMed  CAS  Google Scholar 

  51. Yagi K, Nakamura A, Sekine A, et al. Nonsteroidal anti-inflammatory drug-associated colitis with a histology of collagenous colitis. Endoscopy. 2001;33:629–632.

    Article  PubMed  CAS  Google Scholar 

  52. Pascua MF, Kedia P, Weiner M, et al. Microscopic colitis and medication use [abstract]. Gastroenterology. 2009;136:A-366.

    Article  Google Scholar 

  53. Fernandez-Banares F, Esteve M, Espinos JC, et al. Drug consumption and the risk of microscopic colitis. Am J Gastroenterol. 2007;102:324–330.

    Article  PubMed  Google Scholar 

  54. Dube C, Rostom A, Lewin G, et al. The use of aspirin for primary prevention of colorectal cancer: a systematic review prepared for the U.S. Preventive Services Task Force. Ann Intern Med. 2007;146:365–375.

    PubMed  Google Scholar 

  55. Rostom A, Dube C, Lewin G, et al. Nonsteroidal anti-inflammatory drugs and cyclooxygenase-2 inhibitors for primary prevention of colorectal cancer: a systematic review prepared for the U.S. Preventive Services Task Force. Ann Intern Med. 2007;146:376–389.

    PubMed  Google Scholar 

  56. Pignone M, Anderson GK, Binns K, et al. Aspirin use among adults aged 40 and older in the United States: results of a national survey. Am J Prev Med. 2007;32:403–407.

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Division of Gastroenterology, Pritzker School of Medicine, University of Chicago, NorthShore University HealthSystem, 2650 Ridge Avenue, Suite G221, Evanston, IL, 60201, USA

    Eugene F. Yen, Laura K. Bianchi & Hemant K. Roy

  2. Division of Pathology, NorthShore University HealthSystem, Evanston, IL, USA

    Curtis R. Hall & Benjamin L. Witt

  3. Department of Internal Medicine, St. Francis Hospital, Evanston, IL, USA

    Bhupesh Pokhrel

  4. Center for Clinical and Research Informatics, NorthShore University HealthSystem, Evanston, IL, USA

    Hongyan Du

  5. Department of Internal Medicine, Pritzker School of Medicine, University of Chicago, NorthShore University HealthSystem, Evanston, IL, USA

    Amir Patel

Authors
  1. Eugene F. Yen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bhupesh Pokhrel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Laura K. Bianchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hemant K. Roy
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hongyan Du
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Amir Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Curtis R. Hall
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Benjamin L. Witt
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eugene F. Yen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Yen, E.F., Pokhrel, B., Bianchi, L.K. et al. Decreased Colorectal Cancer and Adenoma Risk in Patients with Microscopic Colitis. Dig Dis Sci 57, 161–169 (2012). https://doi.org/10.1007/s10620-011-1852-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-011-1852-2

Keywords

Search

Navigation