Long-Term Natural History of Microscopic Colitis

Julien Loreau (1, 2) , Dana Duricova (2, 3) , Corinne Gower-Rousseau (4, 5) , Guillaume Savoye (6, 7, 8, 9) , Olivier Ganry (10, 11, 12) , Hajer Ben Khadhra (10) , Hélène Sarter (4, 5) , Clara Yzet (1, 2) , Jean-Philippe Le Mouel (1, 2) , Mathieu Kohut (13) , Franck Brazier (14, 2) , Denis Chatelain (10) , Eric Nguyen-Khac (14, 2, 15) , Jean-Louis Dupas (14, 2) , Mathurin Fumery (14, 2, 16)

1 UPJV - Université de Picardie Jules Verne
2 Registre EPIMAD
3 ISCARE I.V.F. a.s., IBD Clinical and Research Center, Prague, Czech Republic.
4 LIRIC - Lille Inflammation Research International Center - U 995
5 Service d'Epidémiologie et de Santé Publique [Lille]
6 Service d'Hépato-Gastroentérologie [CHU Rouen]
7 ADEN - Nutrition, inflammation et dysfonctionnement de l'axe intestin-cerveau
8 IRIB - Institute for Research and Innovation in Biomedicine
9 UNIROUEN UFR Santé - UNIROUEN - UFR Santé
10 CHU Amiens-Picardie
11 CHIMERE - CHirurgie, IMagerie et REgénération tissulaire de l’extrémité céphalique - Caractérisation morphologique et fonctionnelle - UR UPJV 7516
12 Registre général des cancers de la Somme
13 Service de gastroentérologie [clinique St Isabelle]
14 Service d'Hépato Gastroenterologie [CHU Amiens-Picardie]
15 GRAP - Groupe de Recherche sur l'alcool et les pharmacodépendances - UMR INSERM_S 1247
16 PERITOX - Périnatalité et Risques Toxiques - UMR INERIS_I 1

OBJECTIVES: Data on long-term natural history of microscopic colitis (MC), including collagenous (CC) and lymphocytic colitis (LC), are lacking. METHODS: All new cases of MC diagnosed in the Somme area, France, between January 1, 2005, and December 31, 2007, were prospectively included. Colonic biopsies from all patients were reviewed by a group of 4 gastrointestinal pathologist experts to assess the diagnosis of CC or LC. Demographic and clinical data were retrospectively collected from diagnosis to February 28, 2017. RESULTS: One hundred thirty cases of MC, 87 CC and 43 LC, were included (median age at diagnosis: 70 [interquartile range, 61–77] and 48 [IQR, 40–61] years, respectively). The median follow-up was 9.6 years (7.6; 10.6). By the end of the follow-up, 37 patients (28%) relapsed after a median time of 3.9 years (1.2; 5.0) since diagnosis, without significant difference between CC and LC (30% vs 26%; P = 0.47). Twenty patients (15%) were hospitalized for a disease flare, and 32 patients (25%) presented another autoimmune disease. Budesonide was the most widely used treatment (n = 74, 59%), followed by 5-aminosalicylic acid (n = 31, 25%). The median duration of budesonide treatment was 92 days (70; 168), and no adverse event to budesonide was reported. Sixteen patients (22%) developed steroid dependency and 4 (5%) were corticoresistant. No difference in the risk of digestive and extradigestive cancer was observed compared with the general population. None of the death (n = 25) observed during the follow-up were linked to MC. In multivariate analysis, age at diagnosis (HR, 1.03; 95% confidence interval, 1.00–1.06; P = 0.02) and budesonide exposure (HR, 2.50; 95% confidence interval, 1.11–5.55; P = 0.03) were significantly associated with relapse. DISCUSSION: This population-based study showed that after diagnosis, two-third of the patients with MC observed long-term clinical remission. Age at diagnosis and budesonide exposure were associated with a risk of relapse.

Domaines: Hépatologie et Gastroentérologie

Julien Loreau, Dana Duricova, Corinne Gower-Rousseau, Guillaume Savoye, Olivier Ganry, et al.. Long-Term Natural History of Microscopic Colitis. Clinical and translational gastroenterology, 2019, 10 (9), pp.e00071. ⟨10.14309/ctg.0000000000000071⟩. ⟨hal-02368661⟩