The Association Between Microscopic Colitis and Celiac Disease: A Population-Based Study

Abstract

Purpose: Microscopic colitis (MC) and celiac disease (CD) are common causes of chronic diarrhea. In some individuals, failure to respond to treatment of MC may indicate the presence of CD, requiring a gluten-free diet. The aim of this study was to demonstrate the association of MC and CD from an epidemiologic study of MC from 2002 to 2010. Methods: Patients with concomitant MC and CD were identified from a population based epidemiologic study in Olmsted County, MN from January 1, 2002 to December 31, 2010. Patients with MC were identified with either lymphocytic colitis (LC) or collagenous colitis (CC) based on a compatible biopsy and the presence of diarrhea at the time of diagnosis. CD patients were identified by the ICD-9 code 579.0 and confirmed by histopathology and/or measurement of positive serological markers for CD. Results: Of the 183 patients with MC, 6 patients (3.3%) were identified with CD, substantially higher than the observed rate of CD of 1% in the general population. Patients with MC and CD were younger than those with MC alone (age 54.5 vs 66.6 years, p = 0.066). There were no differences in sex, need for one or more courses of corticosteroid treatment for MC, or smoking history (Table 1). Of 6 patients with MC and CD, 3 had LC and 3 had CC. The median age at diagnosis of CD was 55 years old. Of the 4 females, 3 had LC and 1 had CC; both males had CC. CD was diagnosed prior to MC in 4/6 patients with a median time to diagnosis of 359.5 days. CD was diagnosed after MC in 2/6 with an average time to diagnosis of 434.5 days. CD was confirmed in 4/6 patients with small intestinal biopsies and serum antibodies, by serology alone in 1/6, and by small intestinal biopsies alone in 1/6. All patients went on a gluten-free diet with complete response.Table: Demographics of patients with MC alone versus patients with MC and CDConclusion: CD was diagnosed in 3.3% of patients with MC in this population-based cohort, which is significantly higher than the expected rate observed in the general population. Given this increased prevalence of CD in MC, physicians should be suspicious of CD in patients with refractory diarrhea despite treatment for MC, and in those MC patients with any suggestion of malabsorption, such as significant weight loss or iron deficiency anemia.