TY - JOUR

T1 - Disease Activity Patterns, Mortality, and Colorectal Cancer Risk in Microscopic Colitis

T2 - A Danish Nationwide Cohort Study, 2001 to 2016

AU - Weimers, Petra

AU - Ankersen, Dorit Vedel

AU - Lophaven, Søren

AU - Bonderup, Ole Kristian

AU - Münch, Andreas

AU - Løkkegaard, Ellen Christine Leth

AU - Munkholm, Pia

AU - Burisch, Johan

N1 - Publisher Copyright: © 2020 The Author(s) 2020. Published by Oxford University Press on behalf of European Crohn's and Colitis Organisation. All rights reserved.

PY - 2021

Y1 - 2021

N2 - Background and Aims: The disease course of microscopic colitis [MC], encompassing collagenous colitis [CC] and lymphocytic colitis [LC], is not well known. In a Danish nationwide cohort, we evaluated the disease activity patterns as well as the risk of colorectal cancer [CRC] and mortality based on disease severity. Methods: All incident MC patients [n=14 302] with a recorded diagnosis of CC [n=8437] or LC [n=5865] in the Danish Pathology Register, entered between 2001 and 2016, were matched to 10 reference individuals [n=142 481]. Incident cases of CRC after the index date were captured from the Danish Cancer Registry. Mortality data were ascertained from the Danish Registry of Causes of Death, and information about treatment was obtained from the Danish National Prescription Registry. The risk of CRC and mortality analyses were investigated by Cox regression and Kaplan-Meier estimates. Results: We identified a self-limiting or transient disease course in 70.6% of LC patients and in 59.9% of CC patients, p<0.001. Less than 5% of MC patients experienced a budesonide-refractory disease course and were treated with immunomodulators or biologic treatment. A total of 2926 [20.5%] MC patients and 24 632 [17.3%] reference individuals died during the study period. MC patients with a severe disease had a relative risk [RR] of mortality of 1.41 (95% confidence interval [CI]: 1.32-1.50) compared with reference individuals. Only 90 MC patients were diagnosed with CRC during follow-up, corresponding to an RR of 0.48 [95% CI: 0.39-0.60]. Conclusions: A majority of MC patients experience an indolent disease course with a lower risk of developing CRC compared with the background population.

AB - Background and Aims: The disease course of microscopic colitis [MC], encompassing collagenous colitis [CC] and lymphocytic colitis [LC], is not well known. In a Danish nationwide cohort, we evaluated the disease activity patterns as well as the risk of colorectal cancer [CRC] and mortality based on disease severity. Methods: All incident MC patients [n=14 302] with a recorded diagnosis of CC [n=8437] or LC [n=5865] in the Danish Pathology Register, entered between 2001 and 2016, were matched to 10 reference individuals [n=142 481]. Incident cases of CRC after the index date were captured from the Danish Cancer Registry. Mortality data were ascertained from the Danish Registry of Causes of Death, and information about treatment was obtained from the Danish National Prescription Registry. The risk of CRC and mortality analyses were investigated by Cox regression and Kaplan-Meier estimates. Results: We identified a self-limiting or transient disease course in 70.6% of LC patients and in 59.9% of CC patients, p<0.001. Less than 5% of MC patients experienced a budesonide-refractory disease course and were treated with immunomodulators or biologic treatment. A total of 2926 [20.5%] MC patients and 24 632 [17.3%] reference individuals died during the study period. MC patients with a severe disease had a relative risk [RR] of mortality of 1.41 (95% confidence interval [CI]: 1.32-1.50) compared with reference individuals. Only 90 MC patients were diagnosed with CRC during follow-up, corresponding to an RR of 0.48 [95% CI: 0.39-0.60]. Conclusions: A majority of MC patients experience an indolent disease course with a lower risk of developing CRC compared with the background population.

KW - collagenous colitis

KW - colorectal cancer

KW - lymphocytic colitis

KW - Microscopic colitis

KW - mortality

KW - population-based cohort

U2 - 10.1093/ecco-jcc/jjaa207

DO - 10.1093/ecco-jcc/jjaa207

M3 - Journal article

C2 - 33049029

AN - SCOPUS:85104046919

VL - 15

SP - 594

EP - 602

JO - Journal of Crohn's & colitis

JF - Journal of Crohn's & colitis

SN - 1873-9946

IS - 4

ER -