Long Term Outcome Study of Patients with Both Inflammatory Bowel Disease and Microscopic Colitis during the Course of Illness
Stephanie Schulte, Tze Khor, Catherine Hagen, Robert Najarian, Gregory Lauwers, Robert Odze, Amitabh Srivastava. Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital, Boston, MA; Dartmouth-Hitchcock Medical Center, Dover, NH; Beth Israel Deaconess Medical Center, Boston, MA
Background: Rarely, patients with IBD develop a microscopic colitis (MC)-like illness and, conversely, some patients with microscopic colitis develop an IBD-like illness. The aim of this study was to evaluate the clinical, endoscopic, and pathologic features of patients with IBD who also had a prior, concurrent or subsequent diagnosis of MC during the course of illness in order to determine the relationship, if any, between these disorders.
Design: The study group consisted of 20 patients (M/F: 5/15; mean age 61; range 23-85) who had a diagnosis consistent with both IBD and MC at different time points during their illness. These patients were collected via a search through the pathology files of four large hospitals over a 15 year period. Clinical and endoscopic findings at each colonoscopy, treatment history, and patient outcome were determined by chart review. All biopsies were reviewed to confirm of the diagnosis.
Results: Of the 20 study patients, 13 had clinical and pathologic features of IBD [8 Crohn's disease (CD), 5 ulcerative colitis (UC)] followed by development of a collagenous colitis (CC) (N=6) or lymphocytic colitis (LC)-like illness (N=7). 4 of 6 patients who developed CC, and 5/7 patients who developed LC, had clinical and pathologic confirmation of the diagnosis (watery diarrhea, normal endoscopy), whereas the remainder (2/6 CC and 2/7 LC patients) had pathologic features of MC in their biopsies, but had clinical and/or endoscopic features of IBD (bloody diarrhea, obstruction, stricture). Of the 7 patients who presented initially with clinically and pathologically confirmed CC (N=6) or LC (N=1), and then developed an IBD-like illness (5 CD, 2 UC), all had clinical and pathologic evidence of IBD at the most recent follow up.
Conclusions: Patients initially diagnosed with IBD who developed MC-like changes with time represent a heterogenous group, including those who develop new onset MC unrelated to IBD, and some who develop MC-like histologic changes in their biopsies, but in patients with established IBD. In contrast, some patients with an initial diagnosis of MC develop true IBD with time. Further studies are needed to determine if MC represents a risk factor for IBD, or if this latter phenomenon represents the coincidental occurrence of two disorders in the same patient.
Tuesday, March 5, 2013 1:00 PM
Poster Session IV # 123, Tuesday Afternoon