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Microscopic Colitis Increases the Risk of Late-Onset IBD

Monika Fischer, MD, FASGE

Monika Fischer, MD, reviewing Khalili H, et al. Gastroenterology 2020 Jan 8.

In a nationwide Swedish cohort study, the diagnosis of microscopic colitis (N=14,000) was associated with a 17-fold increased risk of developing late-in-life–onset IBD compared to the general population, with mean lead times of 3.3 ± 3.2 years to Crohn’s disease (CD) diagnosis and 3.2 ± 3.5 years to ulcerative colitis (UC) diagnosis. The 10-year absolute excess risks of CD and UC were 0.9 (95% confidence interval [CI], 0.7-1.1) and 2.6 (95% CI, 2.2-2.9) percentage points, respectively.

These results suggest a link between microscopic colitis and late-onset IBD; however, the common pathway in pathogenesis still needs further exploration. While the prevalence of IBD in patients with microscopic colitis is low overall (2.7%), it is significantly higher than in individuals without microscopic colitis history (0.2%; odds ratio, 13.8). Therefore, we should consider the potential diagnosis of new-onset IBD in microscopic colitis patients who experience symptomatic relapse after successful treatment in the past, or in those who remain symptomatic despite long-term budesonide or alternative immunosuppressive therapy.

Monika Fischer, MD, FASGE


Khalili H, Burke KE, Roelstraete B, Sachs MC, Olén O, Ludvigsson JF. Microscopic colitis and risk of inflammatory bowel disease in a nationwide cohort study. Gastroenterology 2020 Jan 8. (Epub ahead of print) (

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