Abstract
BackgroundThe long-term natural history of microscopic colitis (MC) (collagenous colitis (CC), lymphocytic colitis (LC)), traditionally considered relapsing but non-progressive diseases, is poorly defined. Whether persistent histologic inflammation in such diseases is associated with an increased risk of colorectal neoplasia (CRN) or extracolonic cancers has not been robustly established.MethodsThis retrospective cohort included diagnosed with MC at a referral center. Rates of CRN and extracolonic cancer were compared to patients undergoing screening colonoscopy (n = 306) and to the United States population using data from the Surveillance, Epidemiology, and End-Results (SEER) program. Standardized incidence ratios (SIR) and 95% confidence intervals were calculated and multivariable regression models used to identify the effect of MC diagnosis and severity on cancer risk.ResultsOur study included 221 patients with microscopic colitis (112 CC, 109 LC) among whom 77% were women. Compared to the colonoscopy control population, MC was associated with similar odds of tubular adenoma (Odds ratio (OR) 1.07, 95% CI 0.69–1.66) or villous adenoma (OR 1.26, 95% CI 0.17–9.42). Compared to patients with a single episode of MC, those with 2 or more episodes had similar risk of colon cancer (OR 0.83, 95% CI 0.20–3.39) or tubular adenoma (OR 1.49 95% CI 0.83–2.67). We also identified no statistical increase in the rates of cancer in the MC population compared to US-SEER data.ConclusionMicroscopic colitis was not associated with increased risk of CRN and extracolonic cancers when compared to controls undergoing colonoscopy or the US SEER population.
Highlights
The long-term natural history of microscopic colitis (MC) (collagenous colitis (CC), lymphocytic colitis (LC)), traditionally considered relapsing but non-progressive diseases, is poorly defined
(2019) 19:1 hepatobiliary tracts including inflammatory bowel diseases (IBD; Crohn’s disease (CD), ulcerative colitis (UC), celiac disease, or primary sclerosing cholangitis, there is an increase in risk of cancer in the target organ that may be independently associated with persistent histologic activity [11,12,13,14,15,16]
The aims of our study were as follows: (1) to examine the life-time risk of colorectal cancer (CRC) in patients with MC when compared to the general population in the United States (US) or to similar patients undergoing colonoscopic screening; and (2) to define if there is an increase in life-time risk of extracolonic cancers in patients with MC
Summary
The long-term natural history of microscopic colitis (MC) (collagenous colitis (CC), lymphocytic colitis (LC)), traditionally considered relapsing but non-progressive diseases, is poorly defined. The incidence of MC has been reported to be between 1 and 24 per 100,000 person-years in North America and Europe from population-based studies [1,2,3,4,5,6] It comprises two subtypes, collagenous colitis (CC) and lymphocytic colitis (LC) that share many clinical and epidemiological characteristics including female predominance and a normal colonoscopic mucosal appearance. It is well established that for various chronic inflammatory diseases involving the gastrointestinal and (2019) 19:1 hepatobiliary tracts including inflammatory bowel diseases (IBD; Crohn’s disease (CD), ulcerative colitis (UC), celiac disease, or primary sclerosing cholangitis, there is an increase in risk of cancer in the target organ that may be independently associated with persistent histologic activity [11,12,13,14,15,16]. Whether there is an increase in risk of extraintestinal cancers in MC has not been previously established
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