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Jonas F. Ludvigsson - One of the best experts on this subject based on the ideXlab platform.

  • Microscopic Colitis and risk of inflammatory bowel disease in a nationwide cohort study
    Gastroenterology, 2020
    Co-Authors: Hamed Khalili, Bjorn Roelstraete, Kristin E. Burke, Michael C. Sachs, Ola Olén, Jonas F. Ludvigsson
    Abstract:

    Background & Aims Microscopic Colitis shares pathogenetic mechanisms with inflammatory bowel disease (IBD). We studied the association between Microscopic Colitis and risk of incident IBD using data from a nationwide cohort study. Methods We conducted a prospective cohort study of all adults who received a diagnosis of Microscopic Colitis from 1990 through 2017 in Sweden and risk of incident IBD. Cases of Microscopic Colitis (n= 13,957) were identified through Systematized Nomenclature of Medicine codes from the ESPRESSO (Epidemiology Strengthened by histoPathology Reports in Sweden) study, which included gastrointestinal pathology reports from all of Sweden’s 28 centers. Individuals with Microscopic Colitis were matched to 5 general population controls (n = 66,820) and to unaffected siblings (n =13,943). Cox regression was used to estimate adjusted hazard ratio (aHRs) and 95% confidence intervals (CIs). Results Through December of 2017, we identified 323 incident cases of ulcerative Colitis (UC) and 108 incident cases of Crohn’s disease (CD) in patients with Microscopic Colitis compared with 94 UC and 42 CD cases in population comparators. Mean times from diagnosis of Microscopic Colitis to diagnosis of CD was 3.3 ± 3.2 years and to diagnosis of UC was 3.2 ± 3.5 years. In multivariable models, Microscopic Colitis was associated with an aHR of 12.6 (95% CI 8.8–18.1) for CD, 17.3 (95% CI 13.7–21.8) for UC, and 16.8 (95% CI 13.9–20.3) for IBD. The 10-year absolute excess risks of CD and UC were 0.9 (95% CI 0.7–1.1) and 2.6 (95% CI 2.2–2.9) percentage points, respectively. In sensitivity analyses, comparing patients with Microscopic Colitis with their unaffected siblings, the aHRs of CD and UC were 5.4 (95% CI 3.2–9.2) and 9.4 (95% CI 6.4–13.8), respectively. Conclusions In a population-based study in Sweden, we found a significant increase in risk of incident IBD among patients with Microscopic Colitis. Future studies should focus on potential mechanisms underlying these observed associations.

  • Microscopic Colitis and Risk of Inflammatory Bowel Disease in a Nationwide Cohort Study
    Gastroenterology, 2020
    Co-Authors: Hamed Khalili, Bjorn Roelstraete, Kristin E. Burke, Michael C. Sachs, Ola Olén, Jonas F. Ludvigsson
    Abstract:

    Microscopic Colitis shares pathogenetic mechanisms with inflammatory bowel disease (IBD). We studied the association between Microscopic Colitis and risk of incident IBD using data from a nationwide cohort study. We conducted a prospective cohort study of all adults who received a diagnosis of Microscopic Colitis from 1990 through 2017 in Sweden and risk of incident IBD. Cases of Microscopic Colitis (n= 13,957) were identified through Systematized Nomenclature of Medicine codes from the ESPRESSO (Epidemiology Strengthened by histoPathology Reports in Sweden) study, which included gastrointestinal pathology reports from all of Sweden's 28 centers. Individuals with Microscopic Colitis were matched to 5 general population controls (n = 66,820) and to unaffected siblings (n =13,943). Cox regression was used to estimate adjusted hazard ratio (aHRs) and 95% confidence intervals (CIs). Through December of 2017, we identified 323 incident cases of ulcerative Colitis (UC) and 108 incident cases of Crohn's disease (CD) in patients with Microscopic Colitis compared with 94 UC and 42 CD cases in population comparators. Mean times from diagnosis of Microscopic Colitis to diagnosis of CD was 3.3 ± 3.2 years and to diagnosis of UC was 3.2 ± 3.5 years. In multivariable models, Microscopic Colitis was associated with an aHR of 12.6 (95% CI 8.8-18.1) for CD, 17.3 (95% CI 13.7-21.8) for UC, and 16.8 (95% CI 13.9-20.3) for IBD. The 10-year absolute excess risks of CD and UC were 0.9 (95% CI 0.7-1.1) and 2.6 (95% CI 2.2-2.9) percentage points, respectively. In sensitivity analyses, comparing patients with Microscopic Colitis with their unaffected siblings, the aHRs of CD and UC were 5.4 (95% CI 3.2-9.2) and 9.4 (95% CI 6.4-13.8), respectively. In a population-based study in Sweden, we found a significant increase in risk of incident IBD among patients with Microscopic Colitis. Future studies should focus on potential mechanisms underlying these observed associations. Copyright © 2020 AGA Institute. Published by Elsevier Inc. All rights reserved.

  • Mortality of Patients With Microscopic Colitis in Sweden.
    Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2019
    Co-Authors: Hamed Khalili, David Bergman, Bjorn Roelstraete, Kristin E. Burke, Michael C. Sachs, Ola Olén, Jonas F. Ludvigsson
    Abstract:

    Background & Aims Microscopic Colitis is one of the most common causes of chronic diarrhea in older populations. We investigated all-cause and cause-specific mortality in patients with Microscopic Colitis. Methods We conducted a nationwide cohort study of all cases of Microscopic Colitis (n = 14,333) diagnosed from 1990 through 2017 in Sweden. Cases of Microscopic Colitis were identified using SNOMED codes from gastrointestinal histopathology reports collected from Sweden’s 28 pathology departments. Each case of Microscopic Colitis was matched to 5 population comparators (n = 68,700). Mortality data were ascertained from Sweden’s cause of death register. We used Cox proportional hazards modeling to estimate adjusted hazard ratios (aHRs) and 95% CIs. Results Through December of 2017, we confirmed 3014 deaths in patients with Microscopic Colitis (27.4/1000 person-years) and 12,534 deaths in matched population comparators (23.3/1000 person-years). This corresponded to a 10-year absolute risk difference of 3.4% (95% CI, 2.1%–4.6%) and an aHR of 1.17 (95% CI, 1.12–1.22). However, further adjustment of models for comorbidity burden reduced the relative risk of death for patients with Microscopic Colitis (aHR, 0.98; 95% CI, 0.94–1.02). In analyses of cause-specific death, Microscopic Colitis was associated with an increased risk of gastrointestinal-related death (aHR, 1.68; 95% CI, 1.38–2.05) and infection-related death (aHR, 1.42 ; 95% CI, 1.11–1.83), but not cancer-related death (aHR, 0.83; 95% CI, 0.76–0.91) or cardiovascular-related death (aHR, 1.02; 95% CI, 0.96–1.10). Conclusions In a nationwide cohort study in Sweden, we found that patients with Microscopic Colitis were at increased risk of death. However, the increase appears to be related to higher burden of comorbidities in this population.

  • a nationwide cohort study of the incidence of Microscopic Colitis in sweden
    Alimentary Pharmacology & Therapeutics, 2019
    Co-Authors: David Bergman, Hamed Khalili, Jonas F. Ludvigsson, Mark S. Clements, Lars Agréus, Rolf Hultcrantz
    Abstract:

    Background Epidemiological studies of Microscopic Colitis have shown varying but increasing incidence rates. Aim To assess the incidence of Microscopic Colitis in Sweden. Methods Nationwide cohort study performed in 1995-2015 based on biopsy reports. Age-specific and age-standardised incidence rates were calculated. Results We identified 13 844 patients with an incident diagnosis of Microscopic Colitis. Lymphocytic Colitis (n = 9238) constituted 67% and collagenous Colitis (n = 4606) 33% of Microscopic Colitis. The mean age at time of diagnosis of Microscopic Colitis was 60.2 years (58.6 for lymphocytic Colitis, 63.3 for collagenous Colitis). The lifetime risk of developing Microscopic Colitis was 0.87% in women (95% confidence interval, CI: 0.85-0.88) and 0.35% in men (95% CI: 0.34-0.36). From 2006, the overall incidence of Microscopic Colitis was approximately 10.5 cases per 100 000 person-years (95% CI: 9.8-11.3) with higher rates in women (72% of cases, incidence rate ratio = 2.4 (95% CI: 2.3-2.5) and the elderly with increasing rates up to 75-79 years. From 2006-2015, there was a significant increase of 1% per year (P = 0.02) in the overall Microscopic Colitis incidence rate in women; the estimated annual percent change was similar, although not statistically significant, in men (P = 0.15). Conclusions In Sweden, the incidence of Microscopic Colitis is still increasing in women, although the rate appears to be stabilising. The incidence is particularly high in women and the elderly up to age 75-79 years. Finally, across a lifetime, 1 in 115 females and 1 in 286 males are expected to be diagnosed with Microscopic Colitis and thus posing a considerable disease burden.

  • A nationwide cohort study of the incidence of Microscopic Colitis in Sweden
    Alimentary pharmacology & therapeutics, 2019
    Co-Authors: David Bergman, Hamed Khalili, Mark S. Clements, Lars Agréus, Rolf Hultcrantz, Jonas F. Ludvigsson
    Abstract:

    Epidemiological studies of Microscopic Colitis have shown varying but increasing incidence rates. To assess the incidence of Microscopic Colitis in Sweden. Nationwide cohort study performed in 1995-2015 based on biopsy reports. Age-specific and age-standardised incidence rates were calculated. We identified 13 844 patients with an incident diagnosis of Microscopic Colitis. Lymphocytic Colitis (n = 9238) constituted 67% and collagenous Colitis (n = 4606) 33% of Microscopic Colitis. The mean age at time of diagnosis of Microscopic Colitis was 60.2 years (58.6 for lymphocytic Colitis, 63.3 for collagenous Colitis). The lifetime risk of developing Microscopic Colitis was 0.87% in women (95% confidence interval, CI: 0.85-0.88) and 0.35% in men (95% CI: 0.34-0.36). From 2006, the overall incidence of Microscopic Colitis was approximately 10.5 cases per 100 000 person-years (95% CI: 9.8-11.3) with higher rates in women (72% of cases, incidence rate ratio = 2.4 (95% CI: 2.3-2.5) and the elderly with increasing rates up to 75-79 years. From 2006-2015, there was a significant increase of 1% per year (P = 0.02) in the overall Microscopic Colitis incidence rate in women; the estimated annual percent change was similar, although not statistically significant, in men (P = 0.15). In Sweden, the incidence of Microscopic Colitis is still increasing in women, although the rate appears to be stabilising. The incidence is particularly high in women and the elderly up to age 75-79 years. Finally, across a lifetime, 1 in 115 females and 1 in 286 males are expected to be diagnosed with Microscopic Colitis and thus posing a considerable disease burden. © 2019 John Wiley & Sons Ltd.

Hamed Khalili - One of the best experts on this subject based on the ideXlab platform.

  • Microscopic Colitis and risk of inflammatory bowel disease in a nationwide cohort study
    Gastroenterology, 2020
    Co-Authors: Hamed Khalili, Bjorn Roelstraete, Kristin E. Burke, Michael C. Sachs, Ola Olén, Jonas F. Ludvigsson
    Abstract:

    Background & Aims Microscopic Colitis shares pathogenetic mechanisms with inflammatory bowel disease (IBD). We studied the association between Microscopic Colitis and risk of incident IBD using data from a nationwide cohort study. Methods We conducted a prospective cohort study of all adults who received a diagnosis of Microscopic Colitis from 1990 through 2017 in Sweden and risk of incident IBD. Cases of Microscopic Colitis (n= 13,957) were identified through Systematized Nomenclature of Medicine codes from the ESPRESSO (Epidemiology Strengthened by histoPathology Reports in Sweden) study, which included gastrointestinal pathology reports from all of Sweden’s 28 centers. Individuals with Microscopic Colitis were matched to 5 general population controls (n = 66,820) and to unaffected siblings (n =13,943). Cox regression was used to estimate adjusted hazard ratio (aHRs) and 95% confidence intervals (CIs). Results Through December of 2017, we identified 323 incident cases of ulcerative Colitis (UC) and 108 incident cases of Crohn’s disease (CD) in patients with Microscopic Colitis compared with 94 UC and 42 CD cases in population comparators. Mean times from diagnosis of Microscopic Colitis to diagnosis of CD was 3.3 ± 3.2 years and to diagnosis of UC was 3.2 ± 3.5 years. In multivariable models, Microscopic Colitis was associated with an aHR of 12.6 (95% CI 8.8–18.1) for CD, 17.3 (95% CI 13.7–21.8) for UC, and 16.8 (95% CI 13.9–20.3) for IBD. The 10-year absolute excess risks of CD and UC were 0.9 (95% CI 0.7–1.1) and 2.6 (95% CI 2.2–2.9) percentage points, respectively. In sensitivity analyses, comparing patients with Microscopic Colitis with their unaffected siblings, the aHRs of CD and UC were 5.4 (95% CI 3.2–9.2) and 9.4 (95% CI 6.4–13.8), respectively. Conclusions In a population-based study in Sweden, we found a significant increase in risk of incident IBD among patients with Microscopic Colitis. Future studies should focus on potential mechanisms underlying these observed associations.

  • Microscopic Colitis and Risk of Inflammatory Bowel Disease in a Nationwide Cohort Study
    Gastroenterology, 2020
    Co-Authors: Hamed Khalili, Bjorn Roelstraete, Kristin E. Burke, Michael C. Sachs, Ola Olén, Jonas F. Ludvigsson
    Abstract:

    Microscopic Colitis shares pathogenetic mechanisms with inflammatory bowel disease (IBD). We studied the association between Microscopic Colitis and risk of incident IBD using data from a nationwide cohort study. We conducted a prospective cohort study of all adults who received a diagnosis of Microscopic Colitis from 1990 through 2017 in Sweden and risk of incident IBD. Cases of Microscopic Colitis (n= 13,957) were identified through Systematized Nomenclature of Medicine codes from the ESPRESSO (Epidemiology Strengthened by histoPathology Reports in Sweden) study, which included gastrointestinal pathology reports from all of Sweden's 28 centers. Individuals with Microscopic Colitis were matched to 5 general population controls (n = 66,820) and to unaffected siblings (n =13,943). Cox regression was used to estimate adjusted hazard ratio (aHRs) and 95% confidence intervals (CIs). Through December of 2017, we identified 323 incident cases of ulcerative Colitis (UC) and 108 incident cases of Crohn's disease (CD) in patients with Microscopic Colitis compared with 94 UC and 42 CD cases in population comparators. Mean times from diagnosis of Microscopic Colitis to diagnosis of CD was 3.3 ± 3.2 years and to diagnosis of UC was 3.2 ± 3.5 years. In multivariable models, Microscopic Colitis was associated with an aHR of 12.6 (95% CI 8.8-18.1) for CD, 17.3 (95% CI 13.7-21.8) for UC, and 16.8 (95% CI 13.9-20.3) for IBD. The 10-year absolute excess risks of CD and UC were 0.9 (95% CI 0.7-1.1) and 2.6 (95% CI 2.2-2.9) percentage points, respectively. In sensitivity analyses, comparing patients with Microscopic Colitis with their unaffected siblings, the aHRs of CD and UC were 5.4 (95% CI 3.2-9.2) and 9.4 (95% CI 6.4-13.8), respectively. In a population-based study in Sweden, we found a significant increase in risk of incident IBD among patients with Microscopic Colitis. Future studies should focus on potential mechanisms underlying these observed associations. Copyright © 2020 AGA Institute. Published by Elsevier Inc. All rights reserved.

  • Mortality of Patients With Microscopic Colitis in Sweden.
    Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2019
    Co-Authors: Hamed Khalili, David Bergman, Bjorn Roelstraete, Kristin E. Burke, Michael C. Sachs, Ola Olén, Jonas F. Ludvigsson
    Abstract:

    Background & Aims Microscopic Colitis is one of the most common causes of chronic diarrhea in older populations. We investigated all-cause and cause-specific mortality in patients with Microscopic Colitis. Methods We conducted a nationwide cohort study of all cases of Microscopic Colitis (n = 14,333) diagnosed from 1990 through 2017 in Sweden. Cases of Microscopic Colitis were identified using SNOMED codes from gastrointestinal histopathology reports collected from Sweden’s 28 pathology departments. Each case of Microscopic Colitis was matched to 5 population comparators (n = 68,700). Mortality data were ascertained from Sweden’s cause of death register. We used Cox proportional hazards modeling to estimate adjusted hazard ratios (aHRs) and 95% CIs. Results Through December of 2017, we confirmed 3014 deaths in patients with Microscopic Colitis (27.4/1000 person-years) and 12,534 deaths in matched population comparators (23.3/1000 person-years). This corresponded to a 10-year absolute risk difference of 3.4% (95% CI, 2.1%–4.6%) and an aHR of 1.17 (95% CI, 1.12–1.22). However, further adjustment of models for comorbidity burden reduced the relative risk of death for patients with Microscopic Colitis (aHR, 0.98; 95% CI, 0.94–1.02). In analyses of cause-specific death, Microscopic Colitis was associated with an increased risk of gastrointestinal-related death (aHR, 1.68; 95% CI, 1.38–2.05) and infection-related death (aHR, 1.42 ; 95% CI, 1.11–1.83), but not cancer-related death (aHR, 0.83; 95% CI, 0.76–0.91) or cardiovascular-related death (aHR, 1.02; 95% CI, 0.96–1.10). Conclusions In a nationwide cohort study in Sweden, we found that patients with Microscopic Colitis were at increased risk of death. However, the increase appears to be related to higher burden of comorbidities in this population.

  • a nationwide cohort study of the incidence of Microscopic Colitis in sweden
    Alimentary Pharmacology & Therapeutics, 2019
    Co-Authors: David Bergman, Hamed Khalili, Jonas F. Ludvigsson, Mark S. Clements, Lars Agréus, Rolf Hultcrantz
    Abstract:

    Background Epidemiological studies of Microscopic Colitis have shown varying but increasing incidence rates. Aim To assess the incidence of Microscopic Colitis in Sweden. Methods Nationwide cohort study performed in 1995-2015 based on biopsy reports. Age-specific and age-standardised incidence rates were calculated. Results We identified 13 844 patients with an incident diagnosis of Microscopic Colitis. Lymphocytic Colitis (n = 9238) constituted 67% and collagenous Colitis (n = 4606) 33% of Microscopic Colitis. The mean age at time of diagnosis of Microscopic Colitis was 60.2 years (58.6 for lymphocytic Colitis, 63.3 for collagenous Colitis). The lifetime risk of developing Microscopic Colitis was 0.87% in women (95% confidence interval, CI: 0.85-0.88) and 0.35% in men (95% CI: 0.34-0.36). From 2006, the overall incidence of Microscopic Colitis was approximately 10.5 cases per 100 000 person-years (95% CI: 9.8-11.3) with higher rates in women (72% of cases, incidence rate ratio = 2.4 (95% CI: 2.3-2.5) and the elderly with increasing rates up to 75-79 years. From 2006-2015, there was a significant increase of 1% per year (P = 0.02) in the overall Microscopic Colitis incidence rate in women; the estimated annual percent change was similar, although not statistically significant, in men (P = 0.15). Conclusions In Sweden, the incidence of Microscopic Colitis is still increasing in women, although the rate appears to be stabilising. The incidence is particularly high in women and the elderly up to age 75-79 years. Finally, across a lifetime, 1 in 115 females and 1 in 286 males are expected to be diagnosed with Microscopic Colitis and thus posing a considerable disease burden.

  • A nationwide cohort study of the incidence of Microscopic Colitis in Sweden
    Alimentary pharmacology & therapeutics, 2019
    Co-Authors: David Bergman, Hamed Khalili, Mark S. Clements, Lars Agréus, Rolf Hultcrantz, Jonas F. Ludvigsson
    Abstract:

    Epidemiological studies of Microscopic Colitis have shown varying but increasing incidence rates. To assess the incidence of Microscopic Colitis in Sweden. Nationwide cohort study performed in 1995-2015 based on biopsy reports. Age-specific and age-standardised incidence rates were calculated. We identified 13 844 patients with an incident diagnosis of Microscopic Colitis. Lymphocytic Colitis (n = 9238) constituted 67% and collagenous Colitis (n = 4606) 33% of Microscopic Colitis. The mean age at time of diagnosis of Microscopic Colitis was 60.2 years (58.6 for lymphocytic Colitis, 63.3 for collagenous Colitis). The lifetime risk of developing Microscopic Colitis was 0.87% in women (95% confidence interval, CI: 0.85-0.88) and 0.35% in men (95% CI: 0.34-0.36). From 2006, the overall incidence of Microscopic Colitis was approximately 10.5 cases per 100 000 person-years (95% CI: 9.8-11.3) with higher rates in women (72% of cases, incidence rate ratio = 2.4 (95% CI: 2.3-2.5) and the elderly with increasing rates up to 75-79 years. From 2006-2015, there was a significant increase of 1% per year (P = 0.02) in the overall Microscopic Colitis incidence rate in women; the estimated annual percent change was similar, although not statistically significant, in men (P = 0.15). In Sweden, the incidence of Microscopic Colitis is still increasing in women, although the rate appears to be stabilising. The incidence is particularly high in women and the elderly up to age 75-79 years. Finally, across a lifetime, 1 in 115 females and 1 in 286 males are expected to be diagnosed with Microscopic Colitis and thus posing a considerable disease burden. © 2019 John Wiley & Sons Ltd.

Darrell S. Pardi - One of the best experts on this subject based on the ideXlab platform.

  • Current Approach to the Evaluation and Management of Microscopic Colitis
    Current gastroenterology reports, 2017
    Co-Authors: Thomas G. Cotter, Darrell S. Pardi
    Abstract:

    Purpose of Review Microscopic Colitis is a common cause of chronic watery diarrhea, particularly in the elderly. The accompanying symptoms, which include abdominal pain and fatigue, can markedly impair patients’ quality of life. Diagnosis is based upon characteristic histologic findings of the colonic mucosa. This review focuses on the current approach to evaluation and management of patients with Microscopic Colitis.

  • Case report: Pentoxifylline treatment in Microscopic Colitis.
    Medicine, 2017
    Co-Authors: Thomas G. Cotter, Edward V. Loftus, William J. Tremaine, Amrit K. Kamboj, Stephen B. Hicks, Darrell S. Pardi
    Abstract:

    Rationale Microscopic Colitis is a common cause of diarrhea. Pentoxifylline, a xanthine derivative with anti-tumor necrosis factor-alpha properties, is prescribed for intermittent claudication and other disorders. Our goal was to evaluate the outcomes of patients with Microscopic Colitis treated with pentoxifylline. Patient concerns Nine patients with Microscopic Colitis (8 collagenous Colitis and 1 lymphocytic Colitis) seen at Mayo Clinic, Rochester, between January 1, 1997 and November 30, 2016, were included. The median age was 56.9 years (range 51.6-60.2), 8 were female (89%), and the median disease duration was 64.8 months (range 60-109). The indications for treatment were budesonide refractoriness in 7 patients, budesonide dependence in 1 patient, and budesonide intolerance in 1 patient. Diagnoses A histological diagnosis of Microscopic Colitis was confirmed in all patients. Interventions Pentoxifylline 400 mg three times a day was used for a median of 3 months (range 2.5-8.3). Outcomes Complete response occurred in 1 patient (11%) and partial response in 3 patients (33%). The patient who achieved complete response was treated with pentoxifylline due to budesonide intolerance, and completed 43 months of successful maintenance therapy. There were no adverse effects reported. Lessons The majority of budesonide-experienced patients with active Microscopic Colitis did not respond to pentoxifylline. However, it was well-tolerated, with 1 patient achieving long-term remission and one-third of the cohort having a partial response. Larger controlled studies are required to evaluate the efficacy of pentoxifylline and predictors of response in Microscopic Colitis. In particular, patients who are not budesonide-refractory may be more likely to respond.

  • Symptomatic overlap between Microscopic Colitis and irritable bowel syndrome: A prospective study
    Inflammatory bowel diseases, 2013
    Co-Authors: Rami Abboud, Darrell S. Pardi, Patricia P. Kammer, William J. Tremaine, William J. Sandborn, Edward V. Loftus
    Abstract:

    Abstract BACKGROUND:: Microscopic Colitis and irritable bowel syndrome (IBS) are the common causes of watery diarrhea, abdominal discomfort, and other gastrointestinal symptoms. Previous retrospective data and post hoc analysis of information from a randomized controlled trial have suggested that there is considerable overlap between the symptoms seen in patients with Microscopic Colitis and the symptom-based criteria for IBS. We sought to study this overlap in a prospective cohort. METHODS:: A random cohort of patients with biopsy-proven Microscopic Colitis seen at our institution were administered a symptom questionnaire. Based on their responses, the proportion of patients who met various definitions for IBS was determined. Clinical characteristics of those meeting IBS criteria were compared with those who did not. RESULTS:: In the 120 patients who were included, 38% to 58% met the diagnostic criteria for IBS. These patients tended to be younger and more likely female than those who did not meet IBS criteria. CONCLUSIONS:: Patients with Microscopic Colitis frequently meet the diagnostic criteria for IBS. Therefore, these criteria are not specific enough to exclude the presence of Microscopic Colitis. In patients with watery diarrhea, colonoscopy with mucosal biopsies should be performed if symptoms are not controlled by antidiarrheal medications.

  • Review article: Microscopic Colitis--lymphocytic, collagenous and 'mast cell' Colitis.
    Alimentary pharmacology & therapeutics, 2011
    Co-Authors: Eugene F. Yen, Darrell S. Pardi
    Abstract:

    Aliment Pharmacol Ther 2011; 34: 21–32 Summary Background  Microscopic Colitis is a relatively common cause of chronic diarrhoea in predominantly older adults, traditionally termed lymphocytic Colitis and collagenous Colitis. Increased mast cells found in the colonic biopsies of some patients with chronic diarrhoea may represent a distinct type of Microscopic Colitis. Aim  To provide an updated review of the epidemiology, diagnosis and treatment of Microscopic Colitis, and to discuss the role of mast cells in the gastrointestinal tract and their potential role in cases of functional diarrhoea. Method  A MEDLINE literature search was performed to identify pertinent articles. Relevant clinical abstracts were also reviewed. Results  Incidence rates of Microscopic Colitis (lymphocytic and collagenous Colitis) have increased over time, to levels comparable with other forms of inflammatory bowel disease. The possibility of drug-induced Microscopic Colitis and concomitant coeliac sprue are important considerations when evaluating these patients. There are few controlled treatment trials in Microscopic Colitis, with much of the data on treatment coming from retrospective studies. Mast cells have been implicated in functional bowel disorders, with increased mast cells possibly contributing to cases of otherwise unexplained chronic diarrhoea, although this concept requires further investigation. Conclusions  In patients with Microscopic Colitis, a systematic approach to therapy often leads to satisfactory control of symptoms. The role of mast cells in chronic diarrhoea represents an evolving field, with the potential to offer alternative treatment pathways in patients with otherwise unexplained functional diarrhoea.

  • Observer variability in the histologic diagnosis of Microscopic Colitis.
    Inflammatory bowel diseases, 2009
    Co-Authors: David Limsui, Darrell S. Pardi, Thomas C. Smyrk, Patricia P. Kammer, Susan C. Abraham, Jason T. Lewis, Schuyler O. Sanderson, Ross A. Dierkhising, Alan R. Zinsmeister
    Abstract:

    Background: Microscopic Colitis is diagnosed based on histologic criteria. There has been no investigation of the reproducibility of the histologic diagnosis of Microscopic Colitis. Our aim was to evaluate interobserver and intraobserver variation in this diagnosis. Methods: Colonic biopsies from 90 subjects (20 lymphocytic Colitis, 20 collagenous Colitis, 20 inflammatory bowel disease, and 30 normal) were blindly and independently reviewed by 4 gastrointestinal pathologists. The biopsies were classified by each pathologist into 1 of 6 diagnostic categories: lymphocytic Colitis, collagenous Colitis, active chronic Colitis, focal active Colitis, normal, or other. The slides were then relabeled and blindly reinterpreted 3 months later. The degree of agreement was determined using kappa statistics (λ). Results: Interobserver agreement with the 6 diagnostic categories was 69% (κ = 0.76, 95% CI 0.69, 0.83) and 70% (κ = 0.71, 95% CI 0.61, 0.79) for the first and second observations, respectively. Interobserver agreement with final diagnostic categories of Microscopic Colitis versus nonMicroscopic Colitis was 91% (κ = 0.90, 95% CI 0.82, 0.96) and 88% (κ = 0.83, 95% CI 0.73, 0.92), respectively. Mean intraobserver agreement with the 6 diagnostic categories was 83% (κ = 0.77). Mean intraobserver agreement with the final diagnostic categories of Microscopic Colitis versus nonMicroscopic Colitis was 95% (κ = 0.89). Conclusions: Both interobserver and intraobserver agreement were good in distinguishing among the 6 diagnostic categories, and excellent in distinguishing between Microscopic Colitis and nonMicroscopic Colitis diagnoses. The histologic criteria for Microscopic Colitis provide for consistent and reproducible interindividual and intraindividual diagnoses in the evaluation of colonic biopsies. (Inflamm Bowel Dis 2008)

Edward V. Loftus - One of the best experts on this subject based on the ideXlab platform.

  • Case report: Pentoxifylline treatment in Microscopic Colitis.
    Medicine, 2017
    Co-Authors: Thomas G. Cotter, Edward V. Loftus, William J. Tremaine, Amrit K. Kamboj, Stephen B. Hicks, Darrell S. Pardi
    Abstract:

    Rationale Microscopic Colitis is a common cause of diarrhea. Pentoxifylline, a xanthine derivative with anti-tumor necrosis factor-alpha properties, is prescribed for intermittent claudication and other disorders. Our goal was to evaluate the outcomes of patients with Microscopic Colitis treated with pentoxifylline. Patient concerns Nine patients with Microscopic Colitis (8 collagenous Colitis and 1 lymphocytic Colitis) seen at Mayo Clinic, Rochester, between January 1, 1997 and November 30, 2016, were included. The median age was 56.9 years (range 51.6-60.2), 8 were female (89%), and the median disease duration was 64.8 months (range 60-109). The indications for treatment were budesonide refractoriness in 7 patients, budesonide dependence in 1 patient, and budesonide intolerance in 1 patient. Diagnoses A histological diagnosis of Microscopic Colitis was confirmed in all patients. Interventions Pentoxifylline 400 mg three times a day was used for a median of 3 months (range 2.5-8.3). Outcomes Complete response occurred in 1 patient (11%) and partial response in 3 patients (33%). The patient who achieved complete response was treated with pentoxifylline due to budesonide intolerance, and completed 43 months of successful maintenance therapy. There were no adverse effects reported. Lessons The majority of budesonide-experienced patients with active Microscopic Colitis did not respond to pentoxifylline. However, it was well-tolerated, with 1 patient achieving long-term remission and one-third of the cohort having a partial response. Larger controlled studies are required to evaluate the efficacy of pentoxifylline and predictors of response in Microscopic Colitis. In particular, patients who are not budesonide-refractory may be more likely to respond.

  • Symptomatic overlap between Microscopic Colitis and irritable bowel syndrome: A prospective study
    Inflammatory bowel diseases, 2013
    Co-Authors: Rami Abboud, Darrell S. Pardi, Patricia P. Kammer, William J. Tremaine, William J. Sandborn, Edward V. Loftus
    Abstract:

    Abstract BACKGROUND:: Microscopic Colitis and irritable bowel syndrome (IBS) are the common causes of watery diarrhea, abdominal discomfort, and other gastrointestinal symptoms. Previous retrospective data and post hoc analysis of information from a randomized controlled trial have suggested that there is considerable overlap between the symptoms seen in patients with Microscopic Colitis and the symptom-based criteria for IBS. We sought to study this overlap in a prospective cohort. METHODS:: A random cohort of patients with biopsy-proven Microscopic Colitis seen at our institution were administered a symptom questionnaire. Based on their responses, the proportion of patients who met various definitions for IBS was determined. Clinical characteristics of those meeting IBS criteria were compared with those who did not. RESULTS:: In the 120 patients who were included, 38% to 58% met the diagnostic criteria for IBS. These patients tended to be younger and more likely female than those who did not meet IBS criteria. CONCLUSIONS:: Patients with Microscopic Colitis frequently meet the diagnostic criteria for IBS. Therefore, these criteria are not specific enough to exclude the presence of Microscopic Colitis. In patients with watery diarrhea, colonoscopy with mucosal biopsies should be performed if symptoms are not controlled by antidiarrheal medications.

  • Symptomatic overlap between irritable bowel syndrome and Microscopic Colitis.
    Inflammatory bowel diseases, 2007
    Co-Authors: David Limsui, Darrell S. Pardi, Edward V. Loftus, Patricia P. Kammer, William J. Tremaine, Michael Camilleri, William J. Sandborn
    Abstract:

    Background: Microscopic Colitis is diagnosed on the basis of histologic criteria, and irritable bowel syndrome (IBS) is diagnosed by symptom-based criteria. There has been little investigation into the symptomatic overlap between these conditions. Our aim was to assess the prevalence of symptoms of irritable bowel syndrome in a population-based cohort of patients with Microscopic Colitis. Methods: The Rochester Epidemiology Project (REP), a medical records linkage system providing all health care data for the defined population of Olmsted County, Minnesota, was used to identify all county residents with a diagnosis of Microscopic Colitis between 1985 and 2001. The medical records of these individuals were reviewed to ascertain symptoms consistent with Rome, Rome II, and Manning criteria for irritable bowel syndrome. Results: One hundred thirty-one cases of Microscopic Colitis were identified. Median age at diagnosis was 68 years (range, 24–95); 71% were women. Sixty-nine (53%) and 73 (56%) met Rome and Rome II criteria for irritable bowel syndrome, respectively. Fifty-four (41%) had three or more Manning criteria. Forty-three (33%) had previously been diagnosed with irritable bowel syndrome. Conclusions: In this population-based cohort of histologically confirmed Microscopic Colitis, approximately one-half met symptom-based criteria for the diagnosis of irritable bowel syndrome. The clinical symptom-based criteria for irritable bowel syndrome are not specific enough to rule out the diagnosis of Microscopic Colitis. Therefore, patients with suspected diarrhea-predominant irritable bowel syndrome should undergo biopsies of the colon to investigate for possible Microscopic Colitis if symptoms are not well controlled by antidiarrheal therapy. (Inflamm Bowel Dis 2006)

  • The Epidemiology of Microscopic Colitis: A Population-Based Study in Olmsted County, Minnesota
    Gut, 2006
    Co-Authors: Darrell S. Pardi, Edward V. Loftus, Thomas C. Smyrk, Patricia P. Kammer, William J. Tremaine, Cathy D. Schleck, W. Scott Harmsen, Alan R. Zinsmeister, L. Joseph Melton, William J. Sandborn
    Abstract:

    Objective: Although the epidemiology of Microscopic Colitis has been described in Europe, no such data exist from North America. We studied the incidence, prevalence and temporal trends of Microscopic Colitis in a geographically defined U.S. population. Design and Setting: In this population-based cohort study, residents of Olmsted County, Minnesota with a new diagnosis of Microscopic Colitis, and all who had colon biopsies for evaluation of diarrhea, between 1/1/1985 and 12/31/2001 were identified. Biopsies were reviewed for confirmation (cases) and to identify missed cases (diarrhea biopsies). Main Outcome Measures: Incidence rates, age- and sex-adjusted to the 2000 U.S. white population. Poisson regression assessed the association of calendar period, age, and sex with incidence. Results: We identified 130 incident cases, for an overall rate of 8.6 cases per 100,000 person-years. There was a significant secular trend, with incidence increasing from 1.1 per 100,000 early in the study to 19.6 per 100,000 by the end (p Conclusions: The incidence of Microscopic Colitis has increased significantly over time, and by the end of the study, the incidence and prevalence were significantly higher than reported previously. Microscopic Colitis is associated with older age, and collagenous Colitis is associated with female sex.

  • Microscopic Colitis is not associated with cholecystectomy or appendectomy.
    Inflammatory bowel diseases, 2006
    Co-Authors: Aran W. Laing, Darrell S. Pardi, Edward V. Loftus, Thomas C. Smyrk, Patricia P. Kammer, William J. Tremaine, Cathy D. Schleck, W. Scott Harmsen, Alan R. Zinsmeister, L. Joseph Melton
    Abstract:

    Background: Microscopic Colitis is a common cause of chronic watery diarrhea of unknown origin. Some patients develop diarrhea after cholecystectomy, and some patients with Microscopic Colitis have evidence of bile acid malabsorption. However, the association between cholecystectomy and Microscopic Colitis has not been studied. A protective effect of appendectomy on the development of ulcerative Colitis also has been reported, but its relationship with Microscopic Colitis has not been studied. The aim of this study was to assess cholecystectomy and appendectomy as potential risk factors for the development of Microscopic Colitis in a nested case-control study. Materials and Methods: Using the Rochester Epidemiology Project, we identified all Olmsted County (Minnesota) residents with an initial diagnosis of Microscopic Colitis between January 1, 1985, and December 31, 2001. Rates of antecedent cholecystectomy or appendectomy in patients with Microscopic Colitis were compared with age-, gender-, and calendar year-matched community controls through conditional logistic regression. Results: Microscopic Colitis was identified in 130 cases. Cholecystectomy preceded the diagnosis of Microscopic Colitis in 12 cases (9%) compared with 17 (13%) in the control group (odds ratio [OR] 0.7; 95% CI 0.3–1.5). Appendectomy preceded the diagnosis of Microscopic Colitis in 39 subjects (30%) compared with 28 (22%) in the control group (OR 1.6; 95% CI 0.9–2.7). Similar results were obtained when the analysis was restricted to Microscopic Colitis subtype (lymphocytic Colitis or collagenous Colitis). Conclusions: In this population-based nested case-control study, no significant association was seen between cholecystectomy or appendectomy and the development of Microscopic Colitis or its subtypes.

William J. Sandborn - One of the best experts on this subject based on the ideXlab platform.

  • Symptomatic overlap between Microscopic Colitis and irritable bowel syndrome: A prospective study
    Inflammatory bowel diseases, 2013
    Co-Authors: Rami Abboud, Darrell S. Pardi, Patricia P. Kammer, William J. Tremaine, William J. Sandborn, Edward V. Loftus
    Abstract:

    Abstract BACKGROUND:: Microscopic Colitis and irritable bowel syndrome (IBS) are the common causes of watery diarrhea, abdominal discomfort, and other gastrointestinal symptoms. Previous retrospective data and post hoc analysis of information from a randomized controlled trial have suggested that there is considerable overlap between the symptoms seen in patients with Microscopic Colitis and the symptom-based criteria for IBS. We sought to study this overlap in a prospective cohort. METHODS:: A random cohort of patients with biopsy-proven Microscopic Colitis seen at our institution were administered a symptom questionnaire. Based on their responses, the proportion of patients who met various definitions for IBS was determined. Clinical characteristics of those meeting IBS criteria were compared with those who did not. RESULTS:: In the 120 patients who were included, 38% to 58% met the diagnostic criteria for IBS. These patients tended to be younger and more likely female than those who did not meet IBS criteria. CONCLUSIONS:: Patients with Microscopic Colitis frequently meet the diagnostic criteria for IBS. Therefore, these criteria are not specific enough to exclude the presence of Microscopic Colitis. In patients with watery diarrhea, colonoscopy with mucosal biopsies should be performed if symptoms are not controlled by antidiarrheal medications.

  • Symptomatic overlap between irritable bowel syndrome and Microscopic Colitis.
    Inflammatory bowel diseases, 2007
    Co-Authors: David Limsui, Darrell S. Pardi, Edward V. Loftus, Patricia P. Kammer, William J. Tremaine, Michael Camilleri, William J. Sandborn
    Abstract:

    Background: Microscopic Colitis is diagnosed on the basis of histologic criteria, and irritable bowel syndrome (IBS) is diagnosed by symptom-based criteria. There has been little investigation into the symptomatic overlap between these conditions. Our aim was to assess the prevalence of symptoms of irritable bowel syndrome in a population-based cohort of patients with Microscopic Colitis. Methods: The Rochester Epidemiology Project (REP), a medical records linkage system providing all health care data for the defined population of Olmsted County, Minnesota, was used to identify all county residents with a diagnosis of Microscopic Colitis between 1985 and 2001. The medical records of these individuals were reviewed to ascertain symptoms consistent with Rome, Rome II, and Manning criteria for irritable bowel syndrome. Results: One hundred thirty-one cases of Microscopic Colitis were identified. Median age at diagnosis was 68 years (range, 24–95); 71% were women. Sixty-nine (53%) and 73 (56%) met Rome and Rome II criteria for irritable bowel syndrome, respectively. Fifty-four (41%) had three or more Manning criteria. Forty-three (33%) had previously been diagnosed with irritable bowel syndrome. Conclusions: In this population-based cohort of histologically confirmed Microscopic Colitis, approximately one-half met symptom-based criteria for the diagnosis of irritable bowel syndrome. The clinical symptom-based criteria for irritable bowel syndrome are not specific enough to rule out the diagnosis of Microscopic Colitis. Therefore, patients with suspected diarrhea-predominant irritable bowel syndrome should undergo biopsies of the colon to investigate for possible Microscopic Colitis if symptoms are not well controlled by antidiarrheal therapy. (Inflamm Bowel Dis 2006)

  • The Epidemiology of Microscopic Colitis: A Population-Based Study in Olmsted County, Minnesota
    Gut, 2006
    Co-Authors: Darrell S. Pardi, Edward V. Loftus, Thomas C. Smyrk, Patricia P. Kammer, William J. Tremaine, Cathy D. Schleck, W. Scott Harmsen, Alan R. Zinsmeister, L. Joseph Melton, William J. Sandborn
    Abstract:

    Objective: Although the epidemiology of Microscopic Colitis has been described in Europe, no such data exist from North America. We studied the incidence, prevalence and temporal trends of Microscopic Colitis in a geographically defined U.S. population. Design and Setting: In this population-based cohort study, residents of Olmsted County, Minnesota with a new diagnosis of Microscopic Colitis, and all who had colon biopsies for evaluation of diarrhea, between 1/1/1985 and 12/31/2001 were identified. Biopsies were reviewed for confirmation (cases) and to identify missed cases (diarrhea biopsies). Main Outcome Measures: Incidence rates, age- and sex-adjusted to the 2000 U.S. white population. Poisson regression assessed the association of calendar period, age, and sex with incidence. Results: We identified 130 incident cases, for an overall rate of 8.6 cases per 100,000 person-years. There was a significant secular trend, with incidence increasing from 1.1 per 100,000 early in the study to 19.6 per 100,000 by the end (p Conclusions: The incidence of Microscopic Colitis has increased significantly over time, and by the end of the study, the incidence and prevalence were significantly higher than reported previously. Microscopic Colitis is associated with older age, and collagenous Colitis is associated with female sex.

  • Treatment of refractory Microscopic Colitis with azathioprine and 6-mercaptopurine
    Gastroenterology, 2001
    Co-Authors: Darrell S. Pardi, Edward V. Loftus, William J. Tremaine, William J. Sandborn
    Abstract:

    Many patients with Microscopic Colitis will respond to antidiarrheal medications or to anti-inflammatory therapy with 5-aminosalicylates, although a few require corticosteroids. Some patients do not tolerate corticosteroid side effects, and a small subset are dependent on or refractory to corticosteroids. We report our experience with azathioprine and 6-mercaptopurine in patients with Microscopic Colitis.