Common Cause Of Chronic Diarrhea Research Articles

Risk of cancer in patients with bile acid diarrhoea: a Danish nationwide matched cohort study

ObjectiveBile acid diarrhoea is a common cause of chronic diarrhoea. Increased levels of potentially carcinogenic bile acids in faeces, theoretically, may increase the risk of colorectal cancer in particular, but...

Follow-Up of Microscopic Colitis Patients and Diarrhea Controls at 1 Year

Background and AimsMicroscopic colitis is a common cause of chronic diarrhea, however the clinical course of this disease is poorly understood. We aimed to investigate how patients diagnosed with microscopic colitis were treated in routine clinical practice and how their symptoms compared to patients with other causes of chronic diarrhea at one year follow-up. MethodsWe conducted a case-control study of patients undergoing outpatient colonoscopy to evaluate diarrhea. The study pathologist determined whether patients were classified as microscopic colitis cases or non-microscopic colitis controls. One year after colonoscopy, we interviewed cases (n=74) and controls (n=162) about their diagnosis, medications for diarrhea, and symptom burden. ResultsAt one year follow-up after colonoscopy, 10% of microscopic colitis cases were unaware of the diagnosis, 60% had been prescribed a medication for diarrhea, 40% had fecal urgency, 32% had weight loss, and 21% had fecal incontinence. Among cases, 46% were treated with budesonide. Compared to cases, controls had worse symptoms based on the Microscopic Colitis Disease Activity Index (MCDAI) score with a median MCDAI score of 3.0 (IQR 1.9-4.2) vs 2.3 (IQR 1.4-3.2) at one year follow-up. Controls had more frequent stools, urgency, fecal incontinence, and abdominal pain. ConclusionsIn a cohort of patients with biopsy-confirmed microscopic colitis and diarrhea controls, we found that some cases remained unaware of their diagnosis, many cases had persistent symptoms, and controls had worse symptoms than cases. These findings suggest there are opportunities to improve management of this chronic disease.

Is mastocytic colitis a specific clinical-pathological entity?

The number of intestinal mast cells (MC) is increased in several types of colitis, but the mucosa of patients with chronic non-bloody diarrhea has not been studied. The current study sought to determine the relationship between MC counts and degranulation and the severity of symptoms in patients with chronic loose stools. Following a negative laboratory workup for the most common causes of chronic diarrhea, patients with chronic non-bloody loose stools were included in the study. Patients with macroscopic evidence of inflammation or organic disease were excluded after endoscopy with biopsies. Biopsies from the 179 patients in the study were stained with hematoxylin and eosin and anti-CD117 c-kit antibodies. Immunohistochemistry was used to assess the degree of MC degranulation. Out of the 179 patients, 128 had normal histologic findings suggestive of irritable bowel syndrome and were used as controls. Twenty-four presented with abnormally high MC counts (≥40 MC x HPF), 23 with ≥20 intraepithelial lymphocytes x HPF suggesting lymphocytic colitis, and 4 had both (≥40 MC and ≥20 intraepithelial lymphocytes x HPF). In the patients with high MC counts, figures were significantly higher in the right colon versus the left colon (p=0.016), but degranulation did not differ in the right versus the left colon (p=0.125). No age or sex-related difference was observed (p=0.527 and p=0.859 respectively). The prevalence of abdominal pain and bloating did not differ in the three groups (p=0.959 and p=0.140, respectively). Patients with lymphocytic colitis (p=0.008) and those with high MC counts (p=0.025) had significantly higher evacuation rates compared to controls. There was no difference between these two groups (p=0.831). Mast cell degranulation was not associated with the number of evacuations, abdominal pain, or bloating (p=0.51; p=0.41; p=0.42, respectively). The finding that a significantly higher number of evacuations was linked to increased MC in the colonic mucosa of a subset of patients with otherwise normal laboratory and endoscopic findings suggests that "mastocytic colitis" may be a new clinical-pathological entity responsible for chronic non-bloody diarrhea. Prospective studies with a larger number of patients, as well as endoscopic and histological follow-up, are needed to confirm this hypothesis.

Microbial Associations With Microscopic Colitis.

Microscopic colitis is a relatively common cause of chronic diarrhea and may be linked to luminal factors. Given the essential role of the microbiome in human gut health, analysis of microbiome changes associated with microscopic colitis could provide insights into the development of the disease. We enrolled patients who underwent colonoscopy for diarrhea. An experienced pathologist classified patients as having microscopic colitis (n = 52) or controls (n = 153). Research biopsies were taken from the ascending (ASC) and descending (DES) colon, and the microbiome was characterized with Illumina sequencing. We analyzed the associations between microscopic colitis and microbiome with a series of increasingly complex models adjusted for a range of demographic and health factors. We found that alpha diversity was significantly lower in cases with microscopic colitis compared with that in controls in the DES colon microbiome. In the DES colon, a series of models that adjusted for an increasing number of covariates found taxa significantly associated with microscopic colitis, including Proteobacteria that was enriched in cases and Collinsella that was enriched in controls. While the alpha diversity and taxa were not significantly associated with microscopic colitis in the ASC colon microbiome, the inference P values based on ASC and DES microbiomes were highly correlated. Our study demonstrates an altered microbiome in cases with microscopic colitis compared with that in controls. Because both the cases and controls experienced diarrhea, we have identified candidate taxa that could be mechanistically responsible for the development of microscopic colitis independent of changes to the microbial community caused by diarrhea.

Appendectomy and Future Risk of Microscopic Colitis: A Population-Based Case-Control Study in Sweden

Background and AimsMicroscopic colitis (MC) is an inflammatory bowel disease and a common cause of chronic diarrhea. Appendectomy has been suggested to have immunomodulating effects in the colon, influencing the risk of gastrointestinal disease. The relationship between appendectomy and MC has only been sparsely studied. MethodsThis was a case-control study based on the nationwide ESPRESSO (Epidemiology Strengthened by histoPathology Reports in Sweden) cohort, consisting of histopathological examinations in Sweden, linked to national registers. Patients with MC were matched to population controls by age, sex, calendar year of biopsy, and county of residence. Data on antecedent appendectomy and comorbidities were retrieved from the Patient Register. Unconditional logistic regression models were conducted presenting odds ratios (ORs) and 95% confidence intervals (CIs) adjusted for country of birth and matching factors. Further subanalyses were made based on MC subtypes (lymphocytic colitis and collagenous colitis), follow-up time postappendectomy and severity of appendicitis. ResultsThe study included 14,520 cases of MC and 69,491 controls, among these 7.6% (n = 1103) and 5.1% (n = 3510), respectively, had a previous appendectomy ≥1 year prior to MC or matching date. Patients with a previous appendectomy had an increased risk of MC in total (OR, 1.50; 95% CI, 1.40–1.61) and per the collagenous colitis subtype (OR, 1.67; 95% CI, 1.48–1.88) or lymphocytic colitis subtype (OR, 1.42; 95% CI, 1.30–1.55). The risk remained elevated throughout follow-up, and the highest risk was observed in noncomplicated appendicitis. ConclusionsThis nationwide case-control study found a modestly increased risk of developing MC following appendectomy.

Lack of autoantibodies against collagen and related proteins in collagenous colitis

IntroductionCollagenous colitis (CC) is a common cause of chronic diarrhea and is characterized by a subepithelial thickened collagen layer in the colonic mucosa.It shares many of the characteristics found in autoimmune diseases, but no autoantibodies have been identified. In CC, an imbalance in collagen turnover is evident. The purpose of the present study was to investigate whether any collagen-associated autoantibodies or other antibodies such as TPO and ASCA were present, and if levels of total IgE were increased.MethodsSera from women with active CC were analysed with ELISA for detection of autoantibodies against collagen type III and IV (Col III and IV), matrix metalloproteinase-9 (MMP-9), tissue inhibitors of metalloproteinase-1 (TIMP-1) and tenascin-C (TNC). Sera were also analysed for TPO, ASCA and total IgE. Healthy female blood donors served as controls. The cut-off value in the control group was defined as relative units > 97.5th percentile.ResultsSixty-six women were included (mean age 60 years; range 31–74, mean disease duration 6 years; range 1–22). No autoantibody was significantly overexpressed in the CC population compared to controls. The mean disease duration was lower (p = 0.03) in the subjects who expressed collagen-associated autoantibodies (3.7 years; range 1–14), compared to those who did not (6.4 years; range 1–22). Treatment with budesonide was not associated with any of these autoantibodies.ConclusionNo increased presence of the investigated antibodies could be found in the present study of CC. Neither could antibodies against ASCA or TPO, or elevated levels of IgE, be found. Consequently, no association was found between CC and these proteins, even though this may not be generalizable to other compounds in the collagen layer.

Pathophysiology and Clinical Management of Bile Acid Diarrhea.

Bile acid malabsorption (BAM) represents a common cause of chronic diarrhea whose prevalence is under-investigated. We reviewed the evidence available regarding the pathophysiology and clinical management of bile acid diarrhea (BAD). BAD results from dysregulation of the enterohepatic recirculation of bile acids. It has been estimated that 25–33% of patients with functional diarrhea and irritable bowel syndrome with diarrhea have BAM. Currently, the selenium homotaurocholic acid test is the gold standard for BAD diagnosis and severity assessment. However, it is an expensive method and not widely available. The validation of the utility in the clinical practice of several other serum markers, such as 7α-hydroxy-4-cholesten-3-one (C4) and the fibroblast growth factor 19 (FGF19) is ongoing. The first-line treatment of patients with BAD is bile acid sequestrants. Patients that are refractory to first-line therapy should undergo further diagnostics to confirm the diagnosis and to treat the underlying cause of BAD. An early and correct diagnosis of BAD would improve patient’s quality of life, avoiding additional diagnostic tests that burden health care systems. Considering the limited availability and tolerability of specific medications for BAD treatment, future research is awaited to identify other therapeutic approaches, such as gut microbiota modulating therapies.

The implementation of the Kinyoun staining technique in a resource-limited setting is feasible and reveals a high prevalence of intestinal cryptosporidiosis in patients with HIV

ObjectivesIn resource-limited settings, intestinal Cryptosporidial or coccidian infections are common causes of chronic diarrhea but usually remain undiagnosed by routine stool investigation. Here, the addition of the Kinyoun staining technique after stool concentration was evaluated as an easy and inexpensive method for diagnosis of intestinal parasitic infection in patients with HIV. MethodsThis cross-sectional study investigated patients with HIV with diarrhea and randomly selected patients with HIV without diarrhea as controls. Stool samples were examined by wet mount microscopy and Kinyoun staining after stool concentration. Clinical, sociodemographic, and behavioral data were collected. Statistical analysis was performed using chi-squared test and multivariate regression analysis. ResultsIn total, 163 participants were included (62.0% female, mean age 38.2 [SD ± 10.7] years). Diarrhea was present in 52.1% (85/163). The prevalence of intestinal parasites was 18.4% (30/163). Cryptosporidial infections were more frequent among patients with diarrhea (12.9% [11/85] vs 1.3% [1/78], P = 0.005) and in patients with CD4+ cell count <200 cells/µl (25.9% [7/27] vs 3.7% [5/136], P = 0.001). Risk factors for intestinal parasitic infections were diarrhea and the habit of regularly eating uncooked food. Kinyoun staining was necessary for the detection of cryptosporidiosis. ConclusionIn our cohort, the prevalence of intestinal parasitic infection was high, especially after additional use of Kinyoun staining for detection of Cryptosporidia or intestinal coccidia. Considering its clinical relevance, particularly in individuals at risk, the implementation of this technique should be considered in resource-limited settings.

Epidemiology and Clinical Outcomes of Microscopic Colitis: Preliminary Results From the Loyola University Microscopic Colitis Registry (LUMiCoR).

Microscopic colitis (MC) is a common cause of chronic diarrhea with limited long-term data. We searched the pathology records at our institution from 2008 to 2018 to identify cases of MC. Total sample included patients with either a diagnosis of MC or incomplete MC (MCi).Chart review was performed and data were summarized for descriptive statistics. Logistic regression was used to estimate the unadjusted effects of predictors on MC. A total of 216 patients (88.32% white, 80.56% females, mean age 67.12 +/– 15.79) were studied; 50.00% had CC, 40.28% had LC and 9.72% had MCi. Majority (52.31%) were smokers and 21.84% of females were using some form of hormonal therapy. The odds of LC in reference to CC were significantly higher for those using tricyclic antidepressants (TCAs) (OR: 3.23, 95% C.I: 1.18–8.80, p = 0.02). The odds of smoking, statins, aspirin and beta-blocker use were decreased in MCi in reference to CC (all p < 0.05), 29 (74.35%) patients with unresolved symptoms underwent repeat colonoscopies with biopsies. One case of MCi resolved, 8 (72.73%) out of 11 cases of LC resolved, 2 (18.18%) continued to be LC and 1 (9.09%) transformed to CC, 8 (47.06%) out of 17 cases of CC resolved, 8 (47.06%) continued to be CC and 1 (5.88%) transformed to LC. Majority of patients had CC. TCA use resulted in increased odds of LC in reference to CC. Biopsies from repeat colonoscopies in some patients revealed changes in the pathological diagnoses raising the question of interchangeability of MC (CC to LC and vice versa).

Description of Colonoscopy and Histopathology of Chronic Diarrhea Causes in Non-Neoplasm: Literature Review

Chronic diarrhea is a diarrhea symptom which persists for ≥ 4 weeks as a symptom of a disease. Chronic diarrhea is a symptom which often becomes the patient’s cause to be referred to gastroenterology. In general, the prevalence of chronic diarrhea is approximated to be 5% in each populations, but there are obstacles in diagnosing the cause of chronic diarrhea, due to many differential diagnoses of the cause of chronic diarrhea. The cause of chronic diarrhea could be neoplasm and non-neoplasm. In several studies, through results of colonoscopy and histopathology, it was found that the most common cause of chronic diarrhea was non-neoplasm, including IBD, microscopic colitis as a risk factor, and infectious colitis as a differential diagnosis. Each of those diseases has similar symptoms, but different pathological description. Through descriptions of colonoscopy and histopathology of chronic diarrhea causes, it is possible to differentiate each non-neoplasm causes of chronic diarrhea. It could facilitate in finding the differences among the causes of chronic diarrhea especially in non-neoplasm cases, therefore possibly establishing a definite diagnosis.

P827 The clinical phenotype of collagenous colitis is associated with T-cell-related genetic variants

Abstract Background Collagenous colitis (CC) is a common cause of chronic diarrhoea and highly associated with immune-mediated diseases. The aetiology of CC may involve a dysregulated immune response in genetically predisposed individuals. Our preliminary data identified ancestral HLA haplotype 8.1 and non-HLA CC risk loci being associated with CC. We here carried out the first genotype/clinical phenotype association study in a large cohort of CC patients. Methods This study combined Immunochip data from 300 patients with centrally read histologically confirmed CC with retrospectively collected clinical data in a quarternary care centre. We tested 21 SNPs previously associated with CC (Roda et al. submitted) for their genetic association with selected phenotypic variables (histology, autoimmune diseases, relapse rate, concomitant medications, number of bowel movements at diagnosis, sex and response to therapy). We performed univariable linear, logistic and Poisson regression analyses for associations with the outcome variables. Results 300 CC patients [median age 63 (IQR: 54–63); 80% female] were included after quality control. The genetic variants associated with clinical phenotypes can be found in Table 1. We identified a link of several genes involved in T cell function with CC phenotypes. IL2A was associated with risk of additional autoimmune disorders reinforcing the possible role of T cells in both diseases. RUNX3 involved in Th17 cells and TGF-beta pathways was a risk factor for IEL infiltrates. Notably, we identified two protective factors: one near C5orf30, previously implicated in rheumatoid arthritis and collagen-induced arthritis, was linked with a reduced rate of flares; ZNF365, involved in uric acid excretion and associated with ileal Crohn’s disease, was found protective in relation to collagen band thickness. When assessing non-genetic variables, number of bowel movements correlated with collagen band thickness (p &amp;lt; 0.01); concomitant use of sertraline was protective for relapse rates (p = 0.021), and current smoking (p = 0.022) was linked with relapse rates. Conclusion We found a significant association of T-cell-related genes and CC clinical phenotypes. Additionally, our study identified current smoking and increased collagen band thickness as risk factors for disease severity.

Хологенная диарея: от диагноза к лечению

Bile acid diarrhoea is a common cause of chronic diarrhoea associated with disturbance of the enterohepatic circulation: either excessive biosynthesis/secretion of bile acids or disordered absorption of bile acids in the ileum. At the same time bile acid diarrhoea is an insufficiently studied, frequently underestimated condition, and the questions remain concerning its diagnosis and management. The work discusses the main groups of causes of this pathology, modern diagnostic methods and the difficulties of a differential search. Also, the article offers information about the diet therapy of bile duct diarrhoea and the main groups of administered medications, in particular, modern enterosorbents.

Impact of irritable bowel syndrome and body mass index on mental health - A prospective cross sectional study

Introduction: Irritable bowel syndrome (IBS) is one of the most common causes of chronic diarrhea. Chronic diarrhea has substantial effect on the physical and mental health (MH) of the patient. Aims: The aim of this study was to evaluate the association between IBS with chronic diarrhea and body mass index (BMI) and effect of severity of symptoms, body weight on MH of patients with IBS. Study Design: A prospective cross-sectional study was performed on patients having diarrhea predominant IBS during September 2017–August 2019. Methods: Ninety-seven patients suffering from IBS-D as diagnosed on the basis of Rome criteria IV had were studied. The severity of symptoms in IBS-D where evaluated according to the IBS-score of symptom-severity. MH was assessed by Patient Health Questionnaire-9 questionnaire. Statistical Analysis: SPSS statistical software was used to analyze the data. ANOVA was used to analyze demographic data. Pearson correlation coefficients were used to analyze linear correlation between demographics, BMI, and MH. Multiple regression test was used in MH analysis with respect to predictive role of BMI. Impact of confounding factors was tested with respect to the gender, age, family status, educational status, severity of the symptoms, and BMI. Results considered statistically significant if P

Mortality of Patients With Microscopic Colitis in Sweden

Microscopic colitis is one of the most common causes of chronic diarrhea in older populations. We investigated all-cause and cause-specific mortality in patients with microscopic colitis. We conducted a nationwide cohort study of all cases of microscopic colitis (n = 14,333) diagnosed from 1990 through 2017 in Sweden. Cases of microscopic colitis were identified using SNOMED codes from gastrointestinal histopathology reports collected from Sweden's 28 pathology departments. Each case of microscopic colitis was matched to 5 population comparators (n= 68,700). Mortality data were ascertained from Sweden's cause of death register. We used Cox proportional hazards modeling to estimate adjusted hazard ratios (aHRs) and 95% CIs. Through December of 2017, we confirmed 3014 deaths in patients with microscopic colitis (27.4/1000 person-years) and 12,534 deaths in matched population comparators (23.3/1000 person-years). This corresponded to a 10-year absolute risk difference of 3.4% (95% CI, 2.1%-4.6%) and an aHR of 1.17 (95% CI, 1.12-1.22). However, further adjustment of models for comorbidity burden reduced the relative risk of death for patients with microscopic colitis (aHR, 0.98; 95% CI, 0.94-1.02). In analyses of cause-specific death, microscopic colitis was associated with an increased risk of gastrointestinal-related death (aHR, 1.68; 95% CI, 1.38-2.05) and infection-related death (aHR, 1.42 ; 95% CI, 1.11-1.83), but not cancer-related death (aHR, 0.83; 95% CI, 0.76-0.91) or cardiovascular-related death (aHR, 1.02; 95% CI, 0.96-1.10). In a nationwide cohort study in Sweden, we found that patients with microscopic colitis were at increased risk of death. However, the increase appears to be related to higher burden of comorbidities in this population.

571 Diagnostic Accuracy of Narrow Band Imaging on Endoscopy in Detection of Duodenal Villous Atrophy Using Histopathology as a Gold Standard in Patients Presenting With Chronic Diarrhea

INTRODUCTION: Celiac disease and tropical sprue are common causes of chronic diarrhea &amp; duodenal villous atrophy (DVA). Narrow band imaging (NBI) is chromoendoscopic technique which facilitates detailed visualization of the mucosal surface &amp; allows targeted biopsy and thus increases the diagnostic yield of the biopsy specimen. Hence, we aimed to determine the diagnostic accuracy of NBI in detection of DVA using histopathology as a gold standard in chronic diarrhea patients. METHODS: All patients with diarrhea for &gt;4weeks were enrolled. Endoscopy was performed in all the patients to take duodenal biopsy and simultaneously NBI villous pattern was noted. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV), and diagnostic accuracy of NBI were calculated comparing histopathology. RESULTS: Baseline characteristics are shown in Table 1. NBI findings of total patients were finger shaped (normal villi), gyriform (partial villi atrophy) and flat surface (complete villous atrophy) mucosa as 22.6%, 59.7% and 17.7% respectively. NBI has sensitivity, specificity; PPV, NPV, and diagnostic accuracy were 84.9%, 45.2%, 82.3%, 50.0%, and 75% respectively for the detection of DVA as depicted in Table 2. CONCLUSION: This study showed 93 (75%) of participants had DVA in contrast to another study from Pakistan which revealed DVA in 49.8% of patients. This disparity is likely due to difference in study population. Our patients had normal villi, partial and complete villous atrophy in 31 (25%), 72 (58.1%) &amp; 21 (16.9%) respectively with P value 0.001. Dutta AK et al. found that NBI has sensitivity 81-87%, specificity 93%, NPV 96% and PPV 68-77% to detect DVA. We found sensitivity 85%, specificity 45%, NPV 50% &amp; PPV 82.3%. In our study specificity &amp; NPV were lower than in others as we included mild villous atrophy while most of the studies had a greater proportion of patients with moderate to severe villous atrophy. We found that duration of diarrhea is associated with presence of villous atrophy, as disease duration of &gt;5 months had sensitivity 92.1% and specificity 60% while 5 months had sensitivity &amp; specificity 80% &amp; 31.3% respectively. This association was not observed in previous studies. So we conclude NBI is a promising technique for assessment of duodenal mucosal details in patients with longstanding chronic diarrhea.

698 Epidemiology and Clinical Outcomes of Microscopic Colitis: Preliminary Results From the Loyola University Microscopic Colitis Registry (LUMiCoR)

INTRODUCTION: Microscopic colitis (MC) is a common cause of chronic diarrhea with limited long-term data. MC consists of 2 distinct histopathological diagnoses; Lymphocytic colitis (LC) marked by &gt;20 intraepithelial lymphocytes (IELs) per 100 epithelial cells (ECs) and collagenous colitis (CC) characterized by &gt; or &lt; 20 IELs/100 ECs and a thickened subepithelial collagen band (&gt;10 microns). Recently, variant forms with fewer characteristic features have been reported under different names; “incomplete collagenous colitis (CCi)” and “incomplete lymphocytic colitis (LCi)” raising concern that CCi or LCi may represent different manifestations during the disease course or different stages of disease development. METHODS: We conducted a natural language search of the pathology records at our institution from 2008 to 2018 using the words “lymphocytic colitis” and “collagenous colitis.” The total sample included patients with either a diagnosis of MC or MCi (CCi/LCi). Chart review was performed to obtain data on demographics, comorbidities, medication, diagnosis, treatment and outcomes. Data were analyzed for descriptive statistics. Logistic regression was used to estimate the unadjusted effects of different variables on MC. RESULTS: A total of 216 patients (88.32% white, 80.56% females) with mean age 67 ± 16 were studied; 50% had CC, 40.3% had LC and 9.7% had MCi. The majority (52.3%) were smokers and 21.8% of females were using some form of hormonal therapy (Table 1). There was a statistically significant association between the use of tricyclic antidepressants (TCAs) and LC compared with CC (OR 3.23, 95% CI 1.18-8.80, P = 0.02; Table 2). Smoking, statins, aspirin and beta-blockers were significantly associated with CC compared with MCi (all P &lt; 0.05; Table 3); 29 (13.4%) patients with unresolved symptoms underwent repeat colonoscopies with biopsies. One case of MCi resolved, 8 (72.7%) out of 11 cases of LC resolved, 2 (18.2%) continued to be LC and 1 (9.1%) transformed to CC, 8 (47.1%) out of 17 cases of CC resolved, 8 (47.1%) continued to be CC and 1 (5.9%) transformed to LC. CONCLUSION: The majority of patients had CC. TCA use was more likely to be associated with LC than CC. MCi was less likely to be associated with smoking and medications compared with CC. Biopsies from repeat colonoscopies in some patients revealed changes in the pathological diagnoses raising the question of interchangeability of MC (CC to LC and vice versa). However, our results need to be prospectively validated in a larger population.

Mortality in Microscopic Colitis - A Nationwide Cohort Study in Sweden

Background and Aims: Microscopic colitis is one of the common causes of chronic diarrhea among the elderly. We sought to examine the rates of all-cause and cause-specific mortality in patients with microscopic colitis. Methods: We conducted a nationwide cohort study of all microscopic colitis cases (n = 14,520) diagnosed from 1990 - 2017 in Sweden. Cases of microscopic colitis were identified using SNOMED codes from gastrointestinal histopathology reports collected across Sweden's 28 pathology departments. Each microscopic colitis case was matched to 5 population comparators (n = 69,489). Mortality data were ascertained from the Cause of Death Register. We used Cox proportional hazard modeling to estimate adjusted hazard ratios (aHRs) and 95% CIs. Results: Through December of 2017, we confirmed 3028 deaths in microscopic colitis patients (27.1/1000 person-years) and 12,536 deaths in matched population comparators (23.0/1000 person-years). This corresponded to a 10-year absolute risk difference of 2.5% [1.8%-3.1%] and an aHR of 1.2 [1.1-1.22]. The risk increased with longer disease duration (Ptrend < 0.001) and appeared to be stronger in the collagenous colitis subtype (aHR=1.3; 1.2-1.4) compared to the lymphocytic colitis subtype (1.1; 1.1-1.2, Pheterogeneity = 0.006). In analyses of cause-specific death, microscopic colitis was associated with an increased risk of cardiovascular(adjusted HR = 1.3 [1.2-1.4]), gastrointestinal (aHR = 2.0 [1.6-2.4]), and infection(aHR = 1.7 [1.3-2.2]) -related deaths but not cancer-related death (aHR = 1.0 [0.9-1.1]). Conclusions: In a nationwide cohort study in Sweden, in addition to an increase in risk of all-cause death, microscopic colitis was associated with a significant increase in death from cardiovascular, infection, and gastrointestinal diseases. Funding Statement: This project was funded by the Karolinska Institutet (Ludvigsson), the Stockholm county council (Drs. Ludvigsson and Bergman) and from Janssen corporation. Declaration of Interests: Dr Khalili receives grant funding from Takeda and Pfizer. He has received consulting fees from Abbvie. Dr Ludvigsson coordinates a study on behalf of the Swedish IBD quality register (SWIBREG). Ethical Approval Statement: This study was approved by the Regional Ethics Committee, Stockholm, Sweden (Protocol no 2014/1287-31/4).

Novel associations of bile acid diarrhoea with fatty liver disease and gallstones: a cohort retrospective analysis

BackgroundBile acid diarrhoea (BAD) is a common cause of chronic diarrhoea with a population prevalence of primary BAD around 1%. Previous studies have identified associations with low levels of the...

Biomarkers and Microscopic Colitis: An Unmet Need in Clinical Practice.

One of the most common causes of chronic diarrhea is ascribed to microscopic colitis (MC). MC is classified in subtypes: collagenous colitis (CC) and lymphocytic colitis (LC). Patients with MC report watery, non-bloody diarrhea of chronic course, abdominal pain, weight loss, and fatigue that may impair patient’s health-related quality of life. A greater awareness, and concomitantly an increasing number of diagnoses over the last years, has demonstrated that the incidence and prevalence of MC are on the rise. To date, colonoscopy with histological analysis on multiple biopsies collected along the colon represents the unique accepted procedure used to assess the diagnosis of active MC and to evaluate the response to medical therapy. Therefore, the emerging need for less-invasive procedures that are also rapid, convenient, standardized, and reproducible, has encouraged scientists to turn their attention to the identification of inflammatory markers and other molecules in blood or feces and within the colonic tissue that can confirm a MC diagnosis. This review gives an update on the biomarkers that are potentially available for the identification of inflammatory activity, related to CC and LC.

Immune modulator therapy for microscopic colitis in a case series of 73 patients.

Microscopic colitis (MC) is a common cause of chronic diarrhoea. Various treatment options have been described, but there are limited data describing outcomes of corticosteroid-sparing treatments. To evaluate the outcomes of patients with active MC treated with immune modulators. All patients seen at Mayo Clinic, Rochester between January 1, 1997 and November 30, 2016 with a histological diagnosis of MC were identified. Patients treated with an immune modulator of interest were selected and clinical outcomes recorded. Seventy-three MC patients (50 collagenous colitis and 23 lymphocytic colitis) with a median disease duration of 24 months (range, 7-60) were included. The indications for treatment were budesonide-refractoriness in 66%, budesonide dependence in 29%, and budesonide intolerance in 5%. Median age was 51.8 years (range, 43.4-63.1) and 61 (84%) were female. Thiopurines were used in 49 patients (67%) for a median of 4 months (range, 1.5-15). Complete and partial response occurred in 43% and 22% respectively. Adverse effects resulting in therapy cessation occurred in 17 patients (35%). Twelve patients (16%) were treated with methotrexate for a median of 14 months (3-18.8). Complete and partial response occurred in 58% and 17%, respectively. Anti-TNF therapy was used in 10 patients (14%) for a median of 4 months (range, 2.3-5.5). Complete response occurred in four patients and partial response in four patients. The majority of patients with active MC responded to thiopurines, methotrexate, or anti-TNF therapy. Larger controlled studies are required to confirm the efficacy and safety of these medications in MC.