190 Anti-Depressant Use Does Not Predict Development of Microscopic Colitis: A Retrospective Case-Controlled Study

Abstract

INTRODUCTION: Microscopic Colitis (MC) is a chronic inflammatory disease of the colon that presents with chronic, non-bloody, watery diarrhea and is diagnosed with colonoscopy (CSPY). Literature is mixed on the association of Anti-Depressant (AD) use and their association with MC. We investigated the association of AD's with MC among patients with clinically significant diarrhea. METHODS: We performed a retrospective case-control study of all patients with clinically significant chronic diarrhea whom underwent CSPY to rule out MC from 1/2012–12/2016 at the University of Virginia Hospital. 127 patients diagnosed with MC were propensity score matched to 127 patients with normal biopsies based on age and gender. Patients were excluded if they were <18 years old, inpatients, or had FMT. The primary outcome was history of AD use. The secondary outcome was use of NSAIDs or PPI's. OR was calculated for the primary outcome and binomial logistic regression modeling was used to control for other medication use. Statistical analysis and propensity score matching were performed in R using the MatchIt Package. RESULTS: 55/127 patients with MC and 45/127 patients with normal biopsies used AD's (OR 1.4; 95% CI (0.65–3.04). No differences were observed among the case and control groups with respect to age, gender, celiac disease, or PPI use. No statistical difference was seen in the lymphocytic (LC) vs. collagenous colitis (CC) subtypes among MC patients with AD use. More patients with AD use had LC than CC but this difference was not clinically or statistically significant. Logistic regression revealed that only NSAID use was a predictor of the development of MC (P < 0.001). Anti-depressant use was not a predictor of MC development. Neither combination of AD and NSAID (P = 0.7385) nor AD and PPI use (P = 0.6892) together was predictive of development of MC. CONCLUSION: In this study, a history of AD did not predict a pathologic diagnosis of MC in an at risk population. It remains unclear if PPI's or AD's are associated with the development of MC suggesting that MC development may be iatrogenic. Despite studies on the gut-brain axis and gut microbiota dysbiosis associated with AD's, our series showed no association between AD use and MC. Further studies may prove beneficial in relating the development of MC with long-term AD use and their influence on the microbiome, Based on our data, the diagnosis of MC does not warrant discontinuing AD's especially since depression itself may lead to worsened clinical stability of MC.