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.

Cancer Registry of the Somme Inserm EA DGS EA 4666 Epidemiology and Public Health Service Amiens University Hospital Amiens France

Clinique Sainte Isabelle Abbeville France

Department of Pathology Amiens University Hospital Amiens France

Gastroenterology Unit Epimad Registry Amiens University Hospital Amiens France

Gastroenterology Unit Hôpital Charles Nicolle Rouen University Hospital Epimad Registry Rouen France

ISCARE 1 5 F a s IBD Clinical and Research Center Prague Czech Republic

Lille University and Hospital Public Health Epidemiology and Economic Health Registre Epimad Maison Régionale de la Recherche Clinique Lille France

Lille University Inserm LIRIC Unit UMR 995 Team 5 Faculté de Médecine Lille France

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Lindström CG. “Collagenous colitis” with watery diarrhoea—A new entity? Pathol Eur 1976;11:87–9. PubMed

Fumery M, Kohut M, Gower-Rousseau C, et al. Incidence, clinical presentation, and associated factors of microscopic colitis in northern France: A population-based study. Dig Dis Sci 2016. PubMed

O'Toole A, Coss A, Holleran G, et al. Microscopic colitis: Clinical characteristics, treatment and outcomes in an Irish population. Int J Colorectal Dis 2014;29:799–803. PubMed

Bjørnbak C, Engel PJH, Nielsen PL, et al. Microscopic colitis: Clinical findings, topography and persistence of histopathological subgroups. Aliment Pharmacol Ther 2011;34:1225–34. PubMed

Tong J, Zheng Q, Zhang C, et al. Incidence, prevalence, and temporal trends of microscopic colitis: A systematic review and meta-analysis. Am J Gastroenterol 2015;110:265–76. PubMed

Järnerot G, Tysk C, Bohr J, et al. Collagenous colitis and fecal stream diversion. Gastroenterology 1995;109:449–55. PubMed

Austin LL, Dobbins WO. Studies of the rectal mucosa in coeliac sprue: The intraepithelial lymphocyte. Gut 1988;29:200–5. PubMed PMC

Fischer H, Holst E, Karlsson F, et al. Altered microbiota in microscopic colitis. Gut 2015;64:1185–6. PubMed PMC

Fine KD, Do K, Schulte K, et al. High prevalence of celiac sprue-like HLA-DQ genes and enteropathy in patients with the microscopic colitis syndrome. Am J Gastroenterol 2000;95:1974–82. PubMed

Järnerot G, Hertervig E, Grännö C, et al. Familial occurrence of microscopic colitis: A report on five families. Scand J Gastroenterol 2001;36:959–62. PubMed

Roth B, Manjer J, Ohlsson B. Microscopic colitis and reproductive factors related to exposure to estrogens and progesterone. Drug Target Insights 2013;7:53–62. PubMed PMC

Fernandez-Bañares F, Esteve M, Salas A, et al. Bile acid malabsorption in microscopic colitis and in previously unexplained functional chronic diarrhea. Dig Dis Sci 2001;46:2231–8. PubMed

Beaugerie L, Pardi DS. Review article: Drug-induced microscopic colitis—Proposal for a scoring system and review of the literature. Aliment Pharmacol Ther 2005;22:277–84. PubMed

Münch A, Bohr J, Miehlke S, et al. Low-dose budesonide for maintenance of clinical remission in collagenous colitis: A randomised, placebo-controlled, 12-month trial. Gut 2016;65:47–56. PubMed PMC

Chan JL, Tersmette AC, Offerhaus GJ, et al. Cancer risk in collagenous colitis. Inflamm Bowel Dis 1999;5:40–3. PubMed

Bonner GF, Petras RE, Cheong DM, et al. Short- and long-term follow-up of treatment for lymphocytic and collagenous colitis. Inflamm Bowel Dis 2000;6:85–91. PubMed

Fernández-Bañares F, Salas A, Esteve M, et al. Collagenous and lymphocytic colitis. evaluation of clinical and histological features, response to treatment, and long-term follow-up. Am J Gastroenterol 2003;98:340–7. PubMed

Goff JS, Barnett JL, Pelke T, et al. Collagenous colitis: Histopathology and clinical course. Am J Gastroenterol 1997;92:57–60. PubMed

Gentile NM, Abdalla AA, Khanna S, et al. Outcomes of patients with microscopic colitis treated with corticosteroids: A population-based study. Am J Gastroenterol 2013;108:256–9. PubMed PMC

Sveinsson OA, Orvar KB, Birgisson S, et al. Clinical features of microscopic colitis in a nation-wide follow-up study in Iceland. Scand J Gastroenterol 2008;43:955–60. PubMed

Fernández-Bañares F, de Sousa MR, Salas A, et al. Impact of current smoking on the clinical course of microscopic colitis. Inflamm Bowel Dis 2013;19:1470–6. PubMed

Schneider S, Rampal A, Hebuterne X, et al. Microscopic colitis. Gastroenterol Clin Biol 1998;22:431–41. PubMed

Gower-Rousseau C, Salomez JL, Dupas JL, et al. Incidence of inflammatory bowel disease in northern France (1988-1990). Gut 1994;35:1433–8. PubMed PMC

Olesen M, Eriksson S, Bohr J, et al. Lymphocytic colitis: A retrospective clinical study of 199 Swedish patients. Gut 2004;53:536–41. PubMed PMC

Pardi DS, Ramnath VR, Loftus EV, et al. Lymphocytic colitis: Clinical features, treatment, and outcomes. Am J Gastroenterol 2002;97:2829–33. PubMed

Itzkowitz SH, Yio X. Inflammation and cancer IV. Colorectal cancer in inflammatory bowel disease: The role of inflammation. Am J Physiol Gastrointest Liver Physiol 2004;287:G7–17. PubMed

Tontini GE, Pastorelli L, Spina L, et al. Microscopic colitis and colorectal neoplastic lesion rate in chronic nonbloody diarrhea: A prospective, multicenter study. Inflamm Bowel Dis 2014;20:882–91. PubMed

Yen EF, Pokhrel B, Bianchi LK, et al. Decreased colorectal cancer and adenoma risk in patients with microscopic colitis. Dig Dis Sci 2012;57:161–9. PubMed

Miehlke S, Madisch A, Karimi D, et al. Budesonide is effective in treating lymphocytic colitis: A randomized double-blind placebo-controlled study. Gastroenterology 2009;136:2092–100. PubMed

Miehlke S, Madisch A, Kupcinskas L, et al. Double-blind, double-dummy, randomized, placebo-controlled, multicenter trial of budesonide and mesalamine in collagenous colitis. Gastroenterology 2012;142:S-211.

Faubion WA, Loftus EV, Harmsen WS, et al. The natural history of corticosteroid therapy for inflammatory bowel disease: A population-based study. Gastroenterology 2001;121:255–60. PubMed

Miehlke S, Hansen JB, Madisch A, et al. Risk factors for symptom relapse in collagenous colitis after withdrawal of short-term budesonide therapy. Inflamm Bowel Dis 2013;19:2763–7. PubMed

Abboud R, Pardi DS, Tremaine WJ, et al. Symptomatic overlap between microscopic colitis and irritable bowel syndrome: A prospective study. Inflamm Bowel Dis 2013;19:550–3. PubMed

Limsui D, Pardi DS, Camilleri M, et al. Symptomatic overlap between irritable bowel syndrome and microscopic colitis. Inflamm Bowel Dis 2007;13:175–81. PubMed