The natural history of histological changes in microscopic colitis

Kanika Sehgal; June Tome; Amrit K Kamboj; Ross A Dierkhising; Darrell S Pardi; Sahil Khanna

doi:10.1177/17562848231168237

The natural history of histological changes in microscopic colitis

Therap Adv Gastroenterol. 2023 Apr 27:16:17562848231168237. doi: 10.1177/17562848231168237. eCollection 2023.

Authors

Kanika Sehgal^{1

2}, June Tome³, Amrit K Kamboj², Ross A Dierkhising⁴, Darrell S Pardi², Sahil Khanna⁵

Affiliations

¹ Department of Internal Medicine, Yale New Haven Hospital, New Haven, CT, USA.
² Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
³ Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
⁴ Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA.
⁵ Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.

Abstract

Background: Microscopic colitis (MC) causes chronic diarrhea. It has two histologic subtypes: lymphocytic colitis (LC) and collagenous colitis (CC). Little is known about the natural progression of disease with time and with treatment.

Objectives: We aimed to assess histological changes over time.

Design: We designed a retrospective study including adults diagnosed with MC from January 1992 to January 2020 at Mayo Clinic.

Methods: Pathology reports were reviewed until 31 October 2020. Histological assessments at least 8 weeks apart were considered as adequate follow-up. Histological change from one subtype to the other and resolution were tracked with univariate and multivariable Cox proportional hazards models.

Results: Overall, 416 patients with a median age at diagnosis of 63.9 years with >1 histopathological assessment were identified. Histology at initial diagnosis was CC in 218 (52.4%) patients and LC in 198 (47.6%). No medications were associated with a histological change. However, histological resolution was more likely with the use of aspirin [hazard ratio (HR): 2.10, 95% confidence interval (CI): 1.34-3.31, p = 0.001) and proton-pump inhibitors (PPIs; HR: 2.01, 95% CI: 1.34-3.02, p = 0.001). Histological resolution was more likely with budesonide treatment (HR: 1.86, 95% CI: 1.16-3.00, p = 0.010) and less likely with mesalamine (HR: 0.40, 95% CI: 0.19-0.83, p = 0.014), compared to medications such as prednisone, loperamide, and bismuth. Patients with CC were less likely to change their histology compared to patients with LC (HR: 0.24, 95% CI: 0.14-0.42, p < 0.001). There was no difference in histological resolution between the two subtypes (HR: 0.70, 95% CI: 0.47-1.05, p = 0.084).

Conclusion: Patients with LC have a higher chance of changing their histology as compared to CC. However, histological resolution was associated with the use of PPIs and aspirin, and treatment with budesonide.

Keywords: budesonide; collagenous colitis; diarrhea; histology; lymphocytic colitis; microscopic colitis; resolution.