P234 Recent trends in microscopic colitis: demographics, clinical features and outcomes in a Portuguese cohort
Silva M., Peixoto A., Lopes S., Nunes A.C.-R., Magro F., Macedo G.
Centro Hospitalar São João, Department of Gastroenterology, Porto, Portugal
Microscopic colitis (MC) is a chronic inflammatory bowel disease characterized by chronic watery diarrhea and specific histopathological features. MC is still under-recognized in clinical practice. The authors intend to analyze the demographics, clinical, and therapeutic features and prognosis of patients diagnosed MC.
Retrospective observational study of adult patients with histological diagnosis of MC, between 2008 and 2015, in a tertiary referral center. Data collection was performed from clinical records of the patients. Descriptive statistics, uni and multivariate analysis was performed using IBM SPSS Statistics 22 with p<0.05 deemed to be statistically significant.
During the period of the study there were 25 patients diagnosed with MC (54% women with a median age of 67 (IQR: 48–73) years, followed for a median of 16 (IQR: 4–29) months); lost follow-up in 4 cases. The younger patient had 22-year-old and the oldest had 83-year-old at the time of the diagnosis. There were 13 cases of collagenous and 12 of lymphocytic colitis. Diarrhea was almost invariably present (96%), while abdominal pain (44%), and weight loss (44%) were also frequently reported. The median time since the beginning of symptoms until a definitive diagnosis was 8 (IQR: 3–17) months. On endoscopic evaluation, two (8%) patients presented with abnormal findings, such as mucosal edema and erythema. In four (16%) patients the diagnosis of MC was made after admission due to acute kidney injury and electrolyte disorders (half of these cases were admitted in an intermediate care unit). One (4%) patient was re-admitted, despite treatment with aminosalicylates. Although only one (4%) case was considered to be drug-induced, many patients were taking a variety of medications thought to be associated with MC, including proton pump inhibitors (48%), aspirin/clopidogrel (36%), and SSRIs (28%). The induction treatment of choice in most cases was budesonide (36%) and aminosalicylates (32%). During follow-up, recurrence of symptoms occurred in 36% patients after withdrawal of successful induction therapy. However, budesonide was associated with a lower recurrence rate comparing to aminosalicylates or oral corticosteroids (29% vs. 50%, p=0.036).
Despite MC has a mild course in most cases, a considerable number of our cases were admitted due to severe dehydration with acute kidney injury and electrolyte disorders. Such situations carries a great burden on individual health and health-related costs. Polypharmacy should be a concern in at-risk cases and appropriate treatment (ie, budesonide) must be advocated, following international recommendations.