Microscopic colitis: controversies in clinical symptoms and autoimmune comorbidities

Abstract

Background: Microscopic colitides are chronic immune-inflammatory bowel diseases. The typical presentation is chronic, watery diarrhoea. Inflammation mostly cannot be visualized via macroscopic inspection. The diagnosis thus requires histologic sampling. The clinical picture can vary. New investigations can prove valuable in setting up recommendations. Patients: A total of 103 patients with microscopic colitis (MC) [28 lymphocytic colitis (LC) 27.2%, 75 collagenous colitis (CC) 72.8%] in the Clinical Centre of the University of Debrecen (tertiary care centre) were included, diagnosed between 1993 and 2020. We aimed for a retrospective analysis characterizing Hungarian MC patients. We sought to compare two subgroups of patients (with either LC or CC). Our investigation focussed on dominant alteration of stool habits, autoimmune and allergic comorbidities. Autoimmune diseases were diagnosed in 39% (40) of the patients, allergic diseases in 26.2% ( 27) of patients and 22.2% of tested patients had alimentary hypersensitivity to certain foods (18 cases out of 81 tested). Results: Age of diagnosis was younger in LC (44.5 years, SD: 5.3 vs. 51.9 years, SD: 12.8, differ-ence¼ 7.4 years p ¼ .0151). Autoimmune diseases were equally frequent in the two groups (LC: 10 patients 36%, CC: 30 patients, 40%, difference: 4%, p ¼ .7124). Food-linked hypersensitivities were more common in CC (LC: 1 patient, CC: 17 patients). Difference in allergic diseases (asthma, rhinitis, urticaria) did not differ between groups (LC: 6 patients, 21%; CC: 21 patients, 28%, difference: 7% p ¼ .4739). One-third of the patients did not complain about chronic diarrhoea. These patients had chronic constipation as the main symptom (34 patients, 33%). Conclusion: Pre-existing autoimmune and allergic diseases were common in patients with MC. Chronic watery diarrhoea is not experienced in many cases. The absence of certain symptoms should not be used to rule out the condition.

Contrasting Autoimmune Comorbidities in Microscopic Colitis and Inflammatory Bowel Diseases

“…Our paper is an extension of two of our earlier datasets of patients with microscopic colitis (MC—103 patients) and inflammatory bowel disease (IBD—508 patients) [ 11 , 12 ]. In total, we included 611 patients in the current paper, within four groups.…”

The Metabolomic Profile of Microscopic Colitis Is Affected by Smoking but Not Histopathological Diagnosis, Clinical Course, Symptoms, or Treatment

“…The patients completed a shortened version of the Rome III questionnaire, including only IBS symptoms [23]. Patients who fulfilled the criteria for Rome III were classified as also suffering from IBS-like symptoms since their diagnosis was MC, and thus, it cannot be called IBS [6].…”

Microscopic Colitis: Pathogenesis and Diagnosis

“…The association was higher in younger patients aged 18–49 compared to older patients aged 50–59. Another retrospective study review of 103 patients with microscopic colitis reported that 40 (39%) of patients had an underlying autoimmune disease with no difference between patients with collagenous colitis and lymphocytic colitis [ 34 ]. Hashimoto thyroiditis was the most prevalent autoimmune disease in fourteen patients (35%), followed by rheumatoid arthritis in seven (17.5%), and Sjogren’s syndrome in seven (17.5%).…”