Clinical Characteristics and Treatment Response in Microscopic Colitis Based on Age at Diagnosis: A Multicenter Retrospective Study

Abstract

Background Microscopic colitis (MC) primarily affects older adults; thus, data in younger patients are scarce. Aims To compare clinical characteristics and treatment response by age at diagnosis. Methods This retrospective cohort study was performed at Mayo Clinic and Massachusetts General Hospital. Patients were chosen consecutively using established databases. Patients were 'younger' if age at diagnosis was ≤ 50 years and 'older' if age > 50 years. Treatment outcomes were captured for induction (12 ± 4 weeks), based on the total number of daily stools, and defined as remission (complete resolution), response (≥ 50% improvement), non-response (< 50% improvement), and intolerance. Patients were considered 'responders' if they had remission or response and 'non-responders' if they had nonresponse or intolerance. Results We included 295 patients (52 younger, 243 older). There were no differences in sex, race, MC subtype, and diarrhea severity between groups (all P > 0.05). Younger patients were more likely to have celiac disease (17.3% vs. 5.8%, P = 0.01), while older patients had higher BMI (mean 25.0 vs. 23.8 kg/m 2 , P = 0.04) were more likely smokers (53.9% vs. 34.6%, P = 0.01) and use NSAIDs (48.6% vs. 15.4%, P < 0.01) and statins (22.6% vs. 3.8%, P < 0.01). Overall treatment response was highest for budesonide (88.3%) and did not differ when comparing older to younger patients (90.6% vs. 77.8%, P = 0.12) or by MC subtype (LC, 81.5% vs. CC, 92.9%, P = 0.07). Conclusions There are no significant differences in MC treatment response based on age or disease subtype. These findings support treating patients with MC based on symptom severity rather than age.

Microscopic colitis: Etiopathology, diagnosis, and rational management

“…In routine clinical practice, there is no difference in the treatment of lymphocytic colitis and collagenous colitis, as demonstrated by the approach of current European and American guidelines ( Miehlke et al, 2021 ; Pardi et al, 2016 ; Nguyen et al, 2016 ). No significant differences exist in treatment response with regard to commonly used medications between younger (i.e., ≤50 years) and older (i.e., >50 years) patients with microscopic colitis ( Sonnenberg and Genta, 2022 ; Kamboj et al, 2022 ).…”

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

“…Factors that predict a relapse after budesonide is stopped include a high stool frequency, longer duration of symptoms and older age [33]. The disease subtype (whether lymphocytic colitis or collagenous colitis) does not appear to affect treatment response [34 ▪▪ ]. Low-dose (3–6 mg/day) budesonide is often needed to maintain clinical remission.…”