P0127 - Quantifying Risk Factors for Microscopic Colitis: A Nationwide, Retrospective Cohort Study

Abdul Mohammed, MD, Sara Ghoneim, MD, Neethi Paranji, MD, Nisheet Waghray, MD
MetroHealth Medical Center, Cleveland, OH

Introduction: Microscopic colitis (MC) is associated with several risk factors; however, their relative risk has been variable and not thoroughly evaluated. We aim to quantify the risk of medical comorbidities and medications associated with MC.

Methods: Retrospective analysis of individuals diagnosed with microscopic colitis was performed using a cloud database (IBM Explorys). Explorys aggregates de-identified data across 300 hospitals in the US. ICD 9 and ICD 10 diagnosis codes are mapped using SNOMED CT (Systematized Nomenclature of Medicine - Clinical Terms) hierarchy. Using SNOMED CT codes, individuals with SNOMED CT diagnosis codes of microscopic colitis were identified. Data on medications and medical comorbidities were collected, and odds ratios (OR) were calculated.

Results: A total of 1130 patients were identified with a diagnosis of MC. Among medications, non-steroidal anti-inflammatory agents (OR, 20.2) and proton pump inhibitors (OR, 12.1) were associated with the highest odds of MC. Among medical comorbidities, infectious gastroenteritis (OR, 26.6) and celiac disease (OR, 22.5) had the highest odds of being associated with MC. Tobacco smoking, Psoriasis, Sjogren’s syndrome, Clostridium difficile infection, and malabsorption syndromes all conferred odds greater than 10. (Table 1)

Discussion: Early identification of MC is critical for minimizing morbidity and initiating therapy. Non-steroidal anti-inflammatory agents impair the colonic mucosal barrier by inhibiting cyclooxygenase. The impaired prostaglandin synthesis increases gut permeability, allowing translocation of luminal toxins and bacteria. Proton pump inhibitors have also been postulated to impair the intestinal barrier. The acid-suppressive properties of PPIs may result in intestinal dysbiosis. MC also shares pathogenesis with gastrointestinal infections and malabsorption syndromes. The inflammatory process in MC causes an imbalance in fluid and electrolytes in the colon resulting in chronic diarrhea. Additionally, it has been postulated that an autoimmune-mediated process may lead to the development of MC. By quantifying both pharmacologic and non-pharmacologic risk factors for MC, epidemiological information can be integrated with current clinical algorithms to identify at-risk patients and provide early/effective treatment rapidly.



Disclosures:


Abdul Mohammed, MD, Sara Ghoneim, MD, Neethi Paranji, MD, Nisheet Waghray, MD. P0127 - Quantifying Risk Factors for Microscopic Colitis: A Nationwide, Retrospective Cohort Study, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.