FREQUENCY AND RISK FACTORS OF MICROSCOPIC COLITIS AS A CAUSE OF CHRONIC WATERY DIARRHOEA

Authors

DOI:

https://doi.org/10.55519/JAMC-03-11935

Keywords:

microscopic colitis, colonoscopy, lymphocytic colitis, collagenous colitis

Abstract

Background: Microscopic colitis (MC) is one of the most underdiagnosed conditions leading to chronic watery diarrhoea in patients worldwide. This is the first study of this kind in Pakistan and we aimed to calculate the frequency as well as study the risk factors behind the disease. Methods: This was a prospective cross-sectional study in a tertiary care hospital in Pakistan. A total of 58 participants with chronic watery diarrhoea who had normal colonoscopy were recruited for the study and biopsies were obtained for diagnosing MC. Results: 2 participants out of 58 (3.4%) had biopsy proven microscopic colitis; one patient had a lymphocytic colitis variant and the other had a collagenous colitis variant. The average score based on the MC scoring system was 7.53 in the entire study group. The patient with lymphocytic colitis had a score of 06 while the patient with collagenous colitis had a score of 8. Conclusion: The frequency of microscopic colitis was found to be 3.4% of all cases of chronic watery diarrhoea. A link between MC and autoimmune diseases was also observed. However, we had a limited sample size and encourage future studies to employ a larger sample size in order to get a multifaceted look at the disease process. 

Author Biographies

Sabhita Shabir Shaikh, Dow University of Health Sciences, Karachi

Assistant Professor

Raheela Khalid, Dow University of Health Sciences, Karachi

Medical Officer Department of Medicine

Uzma Bukhari, Dow University of Health Sciences, Karachi

Professor and Chairperson Pathology

Hafeezullah Shaikh, Dow University of Health Sciences, Karachi

Assistant professor

Syeda Aamna Ijtaba Rizvi , Dow University of Health Sciences, Karachi

House officer Department of Surgery

Alveena Shabbir, Dow University of Health Sciences, Karachi

Lecturer Department of Oral Sciences

References

Sun J, Lin J, Parashette K, Zhang J, Fan R. Association of lymphocytic colitis and lactase deficiency in pediatric population. Pathol Res Pract 2015;211(2):138–44.

Bo-Linn GW, Vendrell DD, Lee E, Fordtran JS. An evaluation of the significance of microscopic colitis in patients with chronic diarrhoea. J Clin Invest 1985;75(5):1559–69.

Storr MA. Microscopic colitis: epidemiology, pathophysiology, diagnosis and current management—an update 2013. ISRN Gastroenterol 2013;2013:352718.

Maye H, Safroneeva E, Godat S, Sempoux C, Yan P, Bouzourène H, et al. Increasing incidence of microscopic colitis in a population-based cohort study in Switzerland. Clin Gastroenterol Hepatol 2021;19(10):2205–6.

Miehlke S, Guagnozzi D, Zabana Y, Tontini GE, Kanstrup Fiehn AM, Wildt S, et al. European guidelines on microscopic colitis: United European Gastroenterology and European Microscopic Colitis Group statements and recommendations. United European Gastroenterol J 2021;9(1):13–7.

Turner K, Genta RM, Sonnenberg A. Ethnic distribution of microscopic colitis in the United States. Inflamm Bowel Dis 2015;21(11):2634–9.

Mohamed N, Marais M, Bezuidenhout J. Microscopic colitis as a missed cause of chronic diarrhoea. World J Gastroenterol 2011;17(15):1996–2002.

Hempel KA, Sharma AV. Collagenous and lymphocytic colitis. InStatPearls [Internet] 2021 Sep 18. StatPearls Publishing. [cited 2023 Mar 24]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK541100/

Yen EF, Amusin DB, Yoo J, Ture A, Gentile NM, Goldberg MJ, et al. Nonsteroidal anti-inflammatory drug exposure and the risk of microscopic colitis. BMC Gastroenterol 2022;22(1):367.

Nimri FM, Muhanna A, Almomani Z, Khazaaleh S, Alomari M, Almomani L, et al. The association between microscopic colitis and celiac disease: a systematic review and meta-analysis. Ann Gastroenterol 2022;35(3):281–9.

Bachani P, Kumar L, Kumar N, Fatima M, Naz S, Memon MK, et al. Prevalence of irritable bowel syndrome and frequency of symptoms in the general population of Pakistan. Cureus 2021;13(1):e12541.

Virine B, Chande N, Driman DK. Biopsies from ascending and descending colon are sufficient for diagnosis of microscopic colitis. Clin Gastroenterol Hepatol 2020;18(9):2003–9.

Nielsen OH, Fernandez-Banares F, Sato T, Pardi DS. Microscopic colitis: Etiopathology, diagnosis, and rational management. Elife 2022;11:e79397.

Kane JS, Rotimi O, Everett SM, Samji S, Michelotti F, Ford AC. Development and validation of a scoring system to identify patients with microscopic colitis. Clin Gastroenterol Hepatol 2015;13(6):1125–31.

Aust DE. Histopathology of microscopic colitis. Pathologe 2012;33(Suppl 2):221–4.

Gentile N, Yen EF. Prevalence, pathogenesis, diagnosis, and management of microscopic colitis. Gut Liver 2018;12(3):227–35.

Weimers P, Ankersen DV, Lophaven S, Bonderup OK, Münch A, Løkkegaard EC, et al. Incidence and prevalence of microscopic colitis between 2001 and 2016: a Danish nationwide cohort study. J Crohns Colitis 2020;14(12):1717–23.

Rojo E, Casanova MJ, Gisbert JP. Treatment of microscopic colitis: the role of budesonide and new alternatives for refractory patients. Rev Esp Enferm Dig 2020;112(1):53–8.

Rahman MA, Raihan AS, Ahamed DS, Masud H, Safiullah AB, Khair KB, et al. Symptomatic overlap in patients with diarrhoea predominant irritable bowel syndrome and microscopic colitis in a sub group of Bangladeshi population. Bangladesh Med Res Counc Bull 2012;38(1):33–8.

Khalili H, Burke KE, Roelstraete B, Sachs MC, Olén O, Ludvigsson JF. Microscopic colitis and risk of inflammatory bowel disease in a nationwide cohort study. Gastroenterology 2020;158(6):1574–83.

Takahashi K, Anno T, Matsuda A, Kimura Y, Kawasaki F, Kaku K, et al. Case Report: Onset of Type 1 Diabetes Mellitus in a Patient With Ulcerative Colitis and Sjogren’s Syndrome Under Euthyroid Hashimoto’s Thyroiditis. Front Endocrinol (Lausanne) 2022;13:836102.

Jaruvongvanich V, Poonsombudlert K, Ungprasert P. Smoking and risk of microscopic colitis: a systematic review and meta-analysis. Inflamm Bowel Dis 2019;25(4):672–8.

Abdel Monem SM, Sharaf AL, Alabiad MA, Ibrahim IM. Microscopic Colitis in Patients with‎ Unexplained Chronic Watery non-Bloody Diarrhoea: A Cross Sectional‎ Study‎‎. Afro-Egypt J Infect Endem Dis 2022;12(2):124–33.

Additional Files

Published

2023-07-09