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Abstract
Background. Collagenous colitis (CC) and lymphocytic colitis (LC) are chronic inflammatory disorders of the colon. There is a paucity of data on differences in etiology, natural history, and treatment response between CC and LC. Methods. Between 2002 and 2013, we identified new diagnoses of CC and LC using the Research Patient Data Registry in a tertiary referral center. We used chi square or Fischer’s exact test and Wilcoxon rank-sum tests to compare the differences in clinical characteristics, treatment types, and response rates between LC and CC. Results: Through 2013, we confirmed 131 patients with a new diagnosis of microscopic colitis (MC) (55 LC, 76 CC). Compared to cases of LC, patients with a diagnosis of CC were more likely to be women (86% vs. 69%, p = 0.03), have elevated erythrocyte sedimentation rate (mean 28 vs. 13 mm/h, p = 0.04), and less likely to be diabetic (5% vs. 18%, p = 0.02). Budesonide was the most effective treatment for both CC and LC (94% and 80%, respectively). However, there were no statistically significant differences in response to various treatments according to the type of MC (all p > 0.10). Older age at the time of diagnosis was associated with better response to bismuth subsalicylate (odds ratio: 1.76; 95% confidence interval: 1.21–2.56 for every 5-year increase) for both CC and LC. Conclusion. Despite differences in the clinical characteristics, response rates to available treatments appeared to be similar in both LC and CC. Older patients may have a better response to bismuth subsalicylate therapy.
Acknowledgments
Grant Support: Funded by R01 CA137178, R01 CA050385, P01 CA87969, CA49449, CA67262, P30 DK043351, K24 098311, and K23 DK091742. Dr. Chan is supported by a senior investigator grant from the Crohn’s and Colitis Foundation of America (CCFA). Dr. Khalili is supported by a career development award from the American Gastroenterological Association (AGA) and by National Institute of Diabetes and Digestive and Kidney Diseases (K23 DK099681). Dr. Ricciardiello is supported by the Italian Association for Cancer Research (AIRC – Investigator Grant n. 14281) and by the European Community’s Seventh Framework Program (Pathway-27) under grant agreement n. 311876. Ethical Approval: The institutional review board at the Partners Healthcare approved this study. Data sharing: Requests for access to data, statistical code, questionnaires, and technical processes may be made by contacting the corresponding author at [email protected]. Authors Contributions: Hamed Khalili takes responsibility for the integrity of the work as a whole, from inception to published article. BS – acquisition of data; drafting of the manuscript. KS – acquisition of data; critical revision of the manuscript. GYL – study concept and design; critical revision of the manuscript for important intellectual content. JMR – study concept and design; critical revision of the manuscript. ATC – study concept and design; critical revision of the manuscript. LR – study concept and design; critical revision of the manuscript. HK – DC – study concept and design; acquisition of data; statistical analysis; interpretation of data; drafting of the manuscript.
Declaration of interest: Dr. Richter is a consultant for policy analysis. Dr. Chan has served as a consultant for Bayer Healthcare, Pfizer Inc., and Pozen Inc. Other authors have no financial disclosures. Dr. Ricciardiello has received an unrestricted research grant by SLA Pharma AG.