Anna Wickbom1, Johan Bohr1, Nils Nyhlin1, Anders Eriksson2, Annika Lapidus3, Andreas Münch4, Kjell-Arne Ung5, Lina Vigren6, Åke Öst7, Curt Tysk1. 1. a Department of Gastroenterology, Faculty of Medicine and Health , Örebro University , Örebro , Sweden. 2. b Department of Medicine, Emergency and Geriatrics , Sahlgrenska University Hospital/East Hospital , Gothenburg , Sweden. 3. c Department of Gastroenterology , Ersta Hospital , Stockholm , Sweden. 4. d Department of Clinical and Experimental Medicine, Division of Gastroenterology and Hepatology, Faculty of Health Sciences , Linköping University , Linköping , Sweden. 5. e Department of Internal Medicine , Sahlgrenska University Hospital/Mölndal , Gothenburg , Sweden. 6. f Department of Medicine , Trelleborg Hospital , Trelleborg , Sweden. 7. g Department of Pathology and Cytology , Aleris Medilab , Täby , Sweden.
Abstract
OBJECTIVES: Onset of microscopic colitis (MC) in patients with ulcerative colitis (UC) or Crohn's disease (CD), or vice versa, has been reported occasionally but the subject is not well described. We therefore report a retrospective observational study of such patients and review the literature. METHODS: Forty-six Swedish gastroenterology clinics were contacted about patients with diagnoses of both inflammatory bowel disease (IBD) and MC. Publications were searched on PubMed. RESULTS: We identified 31 patients with onset of MC after a median (range) of 20 (2-52) years after diagnosis of IBD, or vice versa; 21 UC patients developed collagenous colitis (CC) (n = 16) or lymphocytic colitis (LC) (n = 5); nine CD patients developed CC (n = 5) or LC (n = 4); one CC patient developed CD. Of the 21 UC patients, 18 had extensive disease, whereas no consistent phenotype occurred in CD. Literature review revealed 27 comprehensive case reports of patients with diagnoses of both IBD and MC. Thirteen MC patients developed IBD, of which four required colectomy. Fourteen IBD patients later developed MC. There were incomplete clinical data in 115 additional reported patients. CONCLUSIONS: Altogether 173 patients with occurrence of both IBD and MC were found. The most common finding in our patients was onset of CC in a patient with UC. Although these are likely random associations of two different disorders, MC should be considered in the patient with UC or CD if there is onset of chronic watery diarrhoea without endoscopic relapse of IBD.
OBJECTIVES: Onset of microscopic colitis (MC) in patients with ulcerative colitis (UC) or Crohn's disease (CD), or vice versa, has been reported occasionally but the subject is not well described. We therefore report a retrospective observational study of such patients and review the literature. METHODS: Forty-six Swedish gastroenterology clinics were contacted about patients with diagnoses of both inflammatory bowel disease (IBD) and MC. Publications were searched on PubMed. RESULTS: We identified 31 patients with onset of MC after a median (range) of 20 (2-52) years after diagnosis of IBD, or vice versa; 21 UC patients developed collagenous colitis (CC) (n = 16) or lymphocytic colitis (LC) (n = 5); nine CD patients developed CC (n = 5) or LC (n = 4); one CC patient developed CD. Of the 21 UC patients, 18 had extensive disease, whereas no consistent phenotype occurred in CD. Literature review revealed 27 comprehensive case reports of patients with diagnoses of both IBD and MC. Thirteen MC patients developed IBD, of which four required colectomy. Fourteen IBD patients later developed MC. There were incomplete clinical data in 115 additional reported patients. CONCLUSIONS: Altogether 173 patients with occurrence of both IBD and MC were found. The most common finding in our patients was onset of CC in a patient with UC. Although these are likely random associations of two different disorders, MC should be considered in the patient with UC or CD if there is onset of chronic watery diarrhoea without endoscopic relapse of IBD.
Authors: Adam Carstens; Johan Dicksved; Ronald Nelson; Mårten Lindqvist; Anna Andreasson; Johan Bohr; Curt Tysk; Nicholas J Talley; Lars Agréus; Lars Engstrand; Jonas Halfvarson Journal: Clin Transl Gastroenterol Date: 2019-07 Impact factor: 4.488