Microscopic colitis in Denmark: regional variations in risk factors and frequency of endoscopic procedures

J Crohns Colitis. 2021 Jul 7;jjab119. doi: 10.1093/ecco-jcc/jjab119. Online ahead of print.

Abstract

Objective: Microscopic colitis (MC), encompassing collagenous colitis (CC) and lymphocytic colitis (LC), is an increasingly prevalent gastrointestinal disease with an unknown aetiology. Previous research has reported significant differences in the incidence of MC within Denmark, with the lowest incidence found in the most populated region (Capital Region of Denmark). Our aim was to elucidate the causes of these regional differences.

Design: All incident MC patients (n=14,302) with a recorded diagnosis of CC (n=8,437) or LC (n=5,865) entered in The Danish Pathology Register between 2001 and 2016 were matched to 10 reference individuals (n=142,481). Information regarding drug exposure, including proton pump inhibitors (PPIs), selective serotonin reuptake inhibitors (SSRIs), statins and nonsteroidal anti-inflammatory drugs (NSAIDs), were retrieved from The Danish National Prescription Registry. Information regarding endoscopy rate, smoking related diseases and immune-mediated inflammatory diseases were acquired from The Danish National Patient Registry.

Results: Smoking, immune-mediated inflammatory diseases, exposure to PPIs, SSRIs statins and NSAIDs were significantly associated with MC in all Danish regions. The association between drug exposure and MC was weakest in the Capital Region of Denmark with an Odds Ratio of 1.8 (95% confidence interval (CI): 1.61-2.01). The relative risk of undergoing a colonoscopy with biopsy was significantly increased in sex and age-matched controls in all regions compared to controls from the Capital Region of Denmark, with the greatest risk found in the Region of Southern Denmark, 1.37 (95%CI: 1.26-1.50).

Conclusions: The cause of the regional differences in MC incidence in Denmark seems to be multifactorial, including variations in disease awareness and distribution of risk factors.

Keywords: NSAID; PPI; SSRI; collagenous colitis; lymphocytic colitis; microscopic colitis; risk factors; statin.