Alimentary TractIncidence of microscopic colitis in the Netherlands. A nationwide population-based study from 2000 to 2012
Introduction
Microscopic colitis (MC) is an umbrella term for chronic watery diarrhoea with a normal endoscopic appearance of the colonic mucosa, and characteristic histological abnormalities. MC includes two subtypes, i.e. collagenous colitis (CC) and lymphocytic colitis (LC) [1], [2]. Histologically, the hallmark of CC is the presence of a thickened subepithelial collagen layer (10 μm or more), whereas LC is characterized by an increased number of intraepithelial leukocytes [3], [4], [5]. Both MC entities are predominantly found in females over 65 years of age [6]. Whether CC and LC can be considered histopathological variants of the same disease or two different clinical entities is still matter of discussion [7], [8], [9]. Clinically, both CC and LC are characterized by a chronic relapsing course [10], [11]. Although MC is successfully treated with oral budesonide in most cases, the relapse rate after cessation of treatment is 50–80% [12]. The chronic, relapsing, watery diarrhoea is the main contributor to the significantly decreased quality of life in MC patients [13], [14], [15].
Epidemiological studies performed in Sweden reported mean annual incidence rates up to 5.4 per 100,000 person years for CC in 2005–2010 [16] and 4.5 per 100,000 person years for LC in 2004–2008 [17]. Data collected in the US (Olmsted County, Minnesota) between 2002 and 2010, showed incidence rates of 7.1 and 9.5 per 100,000 person years for CC and LC, respectively [18], while a recent Spanish study [19] reported incidence rates of 2.6 and 2.2 per 100,000 person years between 2004 and 2008 for CC and LC, respectively. Most of the epidemiological studies described an increase in incidence rates over time [12], [19], [20], [21], but recent follow-up data of two long-term, regional cohorts showed a stabilization of the incidence rates of both CC and LC over the last 10–15 years [17], [18]. Although differences between countries seem to be present, the number of studies is too limited to draw firm conclusions on the geographical distribution of MC and changes over time.
The majority of epidemiological studies reporting MC incidence rates were based on regional data with populations up to 650,000 inhabitants [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27]. Only one nationwide study was published so far, covering a rather small population of 277,184 inhabitants [28]. To evaluate potential geographical difference and changes over time, and to estimate the disease burden of MC in future, more data on long-term, nationwide incidence rates are warranted. Therefore, the aim of the present study was to assess the mean annual incidence rate of MC in the Netherlands in a nationwide, population-based cohort, spanning a thirteen-year period.
Section snippets
Catchment area
Data on age, size, and sex distribution of the Dutch population between January 1, 2000 and December 31, 2012, were obtained via Statistics Netherlands (www.cbs.nl). In this time period the total population increased with 5.8%, from 15,863,950 inhabitants in 2000 to 16,778,025 in 2012. The age and sex distribution in 2000 and 2012 is shown in Fig. 1.
Pathology registry
The Netherlands has 55 pathology departments on a total of 132 hospitals, of which eight are university hospitals. Each pathology report generated
Patients
A total number of 15,236 excerpts (8820 initial selection and 6416 additional colon reports), belonging to 8238 patients, were extracted from the PALGA registry. After evaluation of all excerpts, 7509 MC patients could be identified of which 7298 patients were diagnosed with MC for the first time between January 1, 2000 and December 31, 2012 (Fig. 2). Patient characteristics, as well as the distribution of the four probability categories are listed in Table 1. A total number of 70 cases were
Discussion
The present nationwide population-based study showed mean annual incidence rates of 1.8 and 1.3 per 100,000 person years for CC and LC, respectively, over the period 2000–2012. The highest age-adjusted incidence rates were reported for females and for subjects between 60 and 69 years of age. In addition, a significant increase over time was observed for the total group of MC, as well as for CC and LC separately.
The mean annual incidence rates reported in the present study were considerably
Conflict of interest
None declared.
Acknowledgements
The conduction of this study was facilitated by an unrestricted research grant from Dr. Falk Pharma to our institution. Dr. Falk Pharma was not involved in the conductance of this study in any other way.
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