title: Microscopic colitis: clinical characteristics, treatment and outcomes in an Irish population.
abstract: OBJECTIVE
  Many aspects of microscopic colitis remain poorly understood. Our aim was to report a single centre experience with this condition.
  
  
  METHODS
  Two hundred and twenty-two patients (52 male, 170 female; median age 64 years; range 32-90) diagnosed between 1993 and 2010 were studied. Medical notes were reviewed, and data on age, gender, clinical features, history of autoimmune diseases, medication use, cigarette smoking, histology and outcome were collected.
  
  
  RESULTS
  There were 99 cases of lymphocytic and 123 of collagenous colitis. Diarrhoea was almost invariably present (98 %) while abdominal pain (24 %), weight loss (10 %), faecal incontinence (8 %) and blood PR (5 %) were also described. Twenty-eight percent had concomitant autoimmune diseases, most commonly coeliac disease. Patients were taking a variety of medications at diagnosis thought to be associated with microscopic colitis including NSAIDs (22 %), aspirin (19 %), statins (15 %), proton pump inhibitors (19 %) and SSRIs (10 %) at diagnosis. Prior to the widespread use of budesonide in our institution, 33 % of patients required two or more medications during therapy compared to 15 % following the introduction of budesonide (p = 0.001). Thirty-eight percent of patients achieved spontaneous remission with either no treatment or simple anti-diarrhoeals. Using a multivariate model, the only factor associated with spontaneous remission was male gender (RR 1.9; 95 % CI 1.0-3.6; p = 0.04). Two patients had refractory microscopic colitis; one required a colectomy while a more recent case has responded to anti-TNFα therapy.
  
  
  CONCLUSIONS
  Microscopic colitis is predominantly a benign and self-limiting disorder. The introduction of budesonide has revolutionised treatment of this lesser studied inflammatory bowel disease.
authors.affiliation: Centre for Colorectal Disease, St Vincent's University Hospital/University College Dublin, Elm Park, Dublin 4, Ireland, aoibhlinn@hotmail.com.
authors.forename: Aoibhlinn
authors.initials: A
authors.lastname: O'Toole
authors.forename: Alan
authors.initials: A
authors.lastname: Coss
authors.forename: Grainne
authors.initials: G
authors.lastname: Holleran
authors.forename: Denise
authors.initials: D
authors.lastname: Keegan
authors.forename: Glen
authors.initials: G
authors.lastname: Doherty
authors.forename: Kieran
authors.initials: K
authors.lastname: Sheahan
authors.forename: Hugh
authors.initials: H
authors.lastname: Mulcahy
authors.forename: Diarmuid
authors.initials: D
authors.lastname: O'Donoghue
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D019819:Budesonide / Q000627:therapeutic use; D046728:Colitis, Microscopic / Q000150:complications / Q000188:drug therapy* / Q000209:etiology* / Q000473:pathology; D003967:Diarrhea / Q000209:etiology; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012075:Remission, Spontaneous; D012189:Retrospective Studies; D016896:Treatment Outcome; D015431:Weight Loss
chemical_list: D000893:Anti-Inflammatory Agents; D019819:Budesonide
references.citation: Lancet. 1997 Nov 8;350(9088):1370
references.pmid: 9365462
references.citation: Gut. 1992 May;33(5):683-6
references.pmid: 1612488
references.citation: Gut. 2004 Mar;53(3):346-50
references.pmid: 14960513
references.citation: Pathol Eur. 1976;11(1):87-9
references.pmid: 934705
references.citation: Gastrointest Endosc. 2000 Mar;51(3):318-26
references.pmid: 10699778
references.citation: Nat Rev Gastroenterol Hepatol. 2009 Sep;6(9):506-7
references.pmid: 19713982
references.citation: Am J Gastroenterol. 2002 Nov;97(11):2829-33
references.pmid: 12425555
references.citation: Gut. 1996 Dec;39(6):846-51
references.pmid: 9038667
references.citation: Gastroenterology. 2014 May;146(5):1222-30.e1-2
references.pmid: 24440672
references.citation: Aliment Pharmacol Ther. 2011 Jun;33(12):1340-9
references.pmid: 21517923
references.citation: Clin Immunol Immunopathol. 1997 Sep;84(3):223-43
references.pmid: 9281381
references.citation: N Engl J Med. 1994 Sep 29;331(13):836-41
references.pmid: 8078529
references.citation: Dig Liver Dis. 2011 Jul;43(7):523-8
references.pmid: 21324756
references.citation: Am J Gastroenterol. 2000 Aug;95(8):1974-82
references.pmid: 10950045
references.citation: J Crohns Colitis. 2011 Dec;5(6):612-8
references.pmid: 22115383
references.citation: Gastroenterology. 1996 Jan;110(1):45-51
references.pmid: 8536887
references.citation: Am J Gastroenterol. 2002 Apr;97(4):794-802
references.pmid: 12003412
references.citation: Inflamm Bowel Dis. 2013 Feb;19(2):411-7
references.pmid: 23344243
references.citation: Clin Gastroenterol Hepatol. 2010 Apr;8(4):391-4
references.pmid: 20036760
references.citation: Dig Liver Dis. 2011 May;43(5):380-5
references.pmid: 21195042
references.citation: Am J Gastroenterol. 2013 Feb;108(2):256-9
references.pmid: 23295275
references.citation: J Autoimmun. 2009 Nov-Dec;33(3-4):197-207
references.pmid: 19819109
references.citation: Gastroenterology. 1997 Jun;112(6):1830-8
references.pmid: 9178673
references.citation: Am J Gastroenterol. 1995 Sep;90(9):1394-400
references.pmid: 7661156
references.citation: Am J Gastroenterol. 2004 Dec;99(12):2459-65
references.pmid: 15571596
references.citation: Eur J Gastroenterol Hepatol. 2002 Nov;14(11):1199-204
references.pmid: 12439114
references.citation: Am J Gastroenterol. 2004 Jun;99(6):1175-90
references.pmid: 15180742