OBJECTIVES Data on long-term natural history of microscopic colitis (MC), including collagenous (CC) and lymphocytic colitis (LC), are lacking. METHODS All new cases of MC diagnosed in the Somme area, France, between January 1, 2005, and December 31, 2007, were prospectively included. Colonic biopsies from all patients were reviewed by a group of 4 gastrointestinal pathologist experts to assess the diagnosis of CC or LC. Demographic and clinical data were retrospectively collected from diagnosis to February 28, 2017. RESULTS One hundred thirty cases of MC, 87 CC and 43 LC, were included (median age at diagnosis: 70 [interquartile range, 61-77] and 48 [IQR, 40-61] years, respectively). The median follow-up was 9.6 years (7.6; 10.6). By the end of the follow-up, 37 patients (28%) relapsed after a median time of 3.9 years (1.2; 5.0) since diagnosis, without significant difference between CC and LC (30% vs 26%; P = 0.47). Twenty patients (15%) were hospitalized for a disease flare, and 32 patients (25%) presented another autoimmune disease. Budesonide was the most widely used treatment (n = 74, 59%), followed by 5-aminosalicylic acid (n = 31, 25%). The median duration of budesonide treatment was 92 days (70; 168), and no adverse event to budesonide was reported. Sixteen patients (22%) developed steroid dependency and 4 (5%) were corticoresistant. No difference in the risk of digestive and extradigestive cancer was observed compared with the general population. None of the death (n = 25) observed during the follow-up were linked to MC. In multivariate analysis, age at diagnosis (HR, 1.03; 95% confidence interval, 1.00-1.06; P = 0.02) and budesonide exposure (HR, 2.50; 95% confidence interval, 1.11-5.55; P = 0.03) were significantly associated with relapse. DISCUSSION This population-based study showed that after diagnosis, two-third of the patients with MC observed long-term clinical remission. Age at diagnosis and budesonide exposure were associated with a risk of relapse.

中文翻译：

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显微镜结肠炎的长期自然史：基于人群的队列。

目的缺乏关于微观结肠炎（MC）的长期自然病史的数据，包括胶原性（CC）和淋巴细胞性结肠炎（LC）。方法前瞻性纳入2005年1月1日至2007年12月31日期间在法国Somme地区诊断出的所有MC新病例。由4位胃肠道病理学家组成的小组对所有患者的结肠活检进行了评估，以评估CC或LC的诊断。回顾性分析从诊断到2017年2月28日的人口统计学和临床​​数据。结果包括130例MC，87 CC和43 LC（诊断时的中位年龄：70 [四分位间距，61-77]和48 [IQR] ，分别为40-61]年）。中位随访时间为9.6年（7.6; 10.6）。截至随访结束，自诊断以来中位时间为3.9年（1.2; 5.0），其中37例（28％）复发，CC和LC之间没有显着差异（30％比26％； P = 0.47）。20名患者（15％）因疾病发作而住院，32名患者（25％）出现另一种自身免疫性疾病。布地奈德是使用最广泛的治疗方法（n = 74，59％），其次是5-氨基水杨酸（n = 31，25％）。布地奈德治疗的中位时间为92天（70; 168），并且未报告布地奈德发生不良事件。16名患者（22％）发展为类固醇依赖，4名患者（5％）具有皮质激素耐药性。与普通人群相比，未观察到消化道和消化道癌的风险差异。随访期间未观察到死亡（n = 25）与MC相关。在多因素分析中，诊断时的年龄（HR，1.03； 95％置信区间，1.00-1.06； P = 0.02）和布地奈德暴露量（HR，2.50； 95％置信区间，1.11-5.55；P = 0.03）与复发显着相关。讨论这项基于人群的研究表明，诊断后，三分之二的MC患者观察到长期临床缓解。诊断时的年龄和布地奈德暴露与复发风险相关。